Bad medicine: chest examination

Spence, Des

doi:10.1136/bmj.e4569

Cited by 11 publications

(6 citation statements)

References 6 publications

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“…While advances in medical imaging may draw into question the value of clinical examination,9 as long as examinations are performed, consideration should be given as to how findings are conveyed in the medical records. Doctors should already be aware of the potential harm that may result from illegibility and ambiguity in their written entries2–8 and prescriptions 10 11.…”

Section: Discussionmentioning

confidence: 99%

Lung sounds: how doctors draw crackles and wheeze

Scott

Presswood

Makubate

et al. 2013

Postgraduate Medical Journal

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There was wide variation in doctors' drawings of identical auscultation findings, and inconsistency in the meaning of symbols both between and within drawings. Doctors risk incorrectly interpreting each other's drawings when they are not effectively labelled. We recommend doctors consider using a written description instead, or draw different findings with distinct symbols or shading, labelling all findings clearly.

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Section: Discussionmentioning

confidence: 99%

Lung sounds: how doctors draw crackles and wheeze

Scott

Presswood

Makubate

et al. 2013

Postgraduate Medical Journal

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“…Respiratory diagnosis may require multiple assessment modalities including clinical and auscultatory examinations, medical imaging, bronchodilator-response testing, spirometry and body fluid analyses. The accurate identification of airway sounds during auscultation is dependent on clinical training and experience [10, 11]. The ability to select and undertake appropriate testing may be restricted in many settings including in community health care and remote areas because of limitations with access to clinical expertise and tests.…”

Section: Introductionmentioning

confidence: 99%

A prospective multicentre study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children

et al. 2019

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Background The differential diagnosis of paediatric respiratory conditions is difficult and suboptimal. Existing diagnostic algorithms are associated with significant error rates, resulting in misdiagnoses, inappropriate use of antibiotics and unacceptable morbidity and mortality. Recent advances in acoustic engineering and artificial intelligence have shown promise in the identification of respiratory conditions based on sound analysis, reducing dependence on diagnostic support services and clinical expertise. We present the results of a diagnostic accuracy study for paediatric respiratory disease using an automated cough-sound analyser. Methods We recorded cough sounds in typical clinical environments and the first five coughs were used in analyses. Analyses were performed using cough data and up to five-symptom input derived from patient/parent-reported history. Comparison was made between the automated cough analyser diagnoses and consensus clinical diagnoses reached by a panel of paediatricians after review of hospital charts and all available investigations. Results A total of 585 subjects aged 29 days to 12 years were included for analysis. The Positive Percent and Negative Percent Agreement values between the automated analyser and the clinical reference were as follows: asthma (97, 91%); pneumonia (87, 85%); lower respiratory tract disease (83, 82%); croup (85, 82%); bronchiolitis (84, 81%). Conclusion: The results indicate that this technology has a role as a high-level diagnostic aid in the assessment of common childhood respiratory disorders. Trial registration Australian and New Zealand Clinical Trial Registry (retrospective) - ACTRN12618001521213 : 11.09.2018.

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“…Both students and general physicians may further be spuriously discouraged from lung auscultation. The British Medical Journal recently published an article where the author wrote ''as a student I always agreed that I heard murmurs, crepitations, and rubs, even when I hadn't […] What I had been taught was highly unreliable […] basic auscultation may have value, but […] crepitation, and all other soft signs do not […] Definitive investigations should be organised on the basis of symptoms, irrespective of clinical findings'' [78]. We strongly disagree with such a provocative and dangerous statement regarding crepitations (crackles) that may contribute to further delay the diagnosis of IPF.…”

Section: Delayed Diagnosismentioning

confidence: 99%

Neglected evidence in idiopathic pulmonary fibrosis: from history to earlier diagnosis

Cordier¹,

Cottin²

2013

Eur Respir J

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This perspective highlights some evidence that has hitherto been neglected, especially because it may not have been sufficiently explicated in the clinical respiratory medicine literature. Idiopathic pulmonary fibrosis (IPF) has appeared only in the second half of the 20th century and, like lung cancer and chronic obstructive pulmonary disease, may be a direct consequence of the cigarette smoking epidemic. It is a disease of lung ageing, with most affected patients being .70 years of age. The relationship between lung ageing and pulmonary fibrosis is further illustrated in the bleomycin mouse model, in which older males develop more fibrosis than young female mice.Earlier diagnosis of IPF is a prerequisite for significant progress to be made in the long-term outcome and prognosis. We consider that only two different yet complementary and realistic approaches could lead to earlier diagnosis of IPF and possibly to allowing more efficient disease management: 1) investigating any patients with early Velcro crackles at lung auscultation through proactive education of, and commitment from, primary care physicians; and 2) using current large-scale lung cancer screening strategies with lowdose high-resolution computed tomography in smokers for the detection of subclinical interstitial lung disease and especially early IPF. @ERSpublications Only two approaches could lead to earlier diagnosis of IPF and more efficient disease management

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Bad medicine: chest examination

Cited by 11 publications

References 6 publications

Lung sounds: how doctors draw crackles and wheeze

Lung sounds: how doctors draw crackles and wheeze

A prospective multicentre study testing the diagnostic accuracy of an automated cough sound centred analytic system for the identification of common respiratory disorders in children

Neglected evidence in idiopathic pulmonary fibrosis: from history to earlier diagnosis

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