Concordance in Discriminating Recordings of Different Lung Sounds Between Physiotherapists

Background: Auscultation is a fundamental part of the physical examination, but its utility has been questioned due to the low inter-rater concordance. We therefore sought to evaluate the concordance of the discrimination of lung sound recordings between experienced physiotherapists.

Methods: Lung sound recordings were selected and validated by an expert panel when Fleiss κ concordance was > 0.75. Eleven recordings were played for subject recognition using a portable computer in their workplace. Results were analyzed using Fleiss κ when looking for concordance between physiotherapists. Univariate regression was performed to determine if there was an association with clinical training, years of experience, academic accomplishment, or university affiliation.

Results: Sixty-nine physiotherapists with a median of 4 years of working experience (interquartile range 2-6 y) completed the study. There was moderate concordance (κ = 0.562; 95% CI 0.462-0.605) for overall lung sound recording discrimination. For continuous and noncontinuous lung sound recordings, discrimination concordance was substantial (κ = 0.63 and κ = 0.76, respectively). A bivariate analysis revealed that years of experience presented an inverse association with stridor recognition.

Conclusions: Concordance between physiotherapists in discriminating recorded lung sounds was moderate. The ability to recognize stridor was inversely associated with years of work experience.