Concordance in Discriminating Recordings of Different Lung Sounds Between Physiotherapists

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.

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.

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.

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