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Observer variability in the pulmonary examination.

C D Mulrow, B L Dolmatch, E R Delong

    Journal of General Internal Medicine
    |November 1, 1986
    PubMed
    Summary
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    Observer variability in pulmonary examinations is high, with significant disagreement among clinicians. Even trained specialists show inconsistency, suggesting training alone doesn't guarantee reliable pulmonary assessments.

    Area of Science:

    • Pulmonary Medicine
    • Clinical Assessment
    • Medical Education

    Background:

    • Pulmonary examination is a fundamental clinical skill.
    • Variability in observer performance can impact patient diagnosis and care.
    • Understanding inter- and intraobserver reliability is crucial for improving diagnostic accuracy.

    Purpose of the Study:

    • To assess observer variability in pulmonary examinations.
    • To compare the consistency of medical students and pulmonary physicians.
    • To evaluate the reliability of detecting different types of pulmonary findings.

    Main Methods:

    • Four blindfolded observers (2 medical students, 2 pulmonary physicians) examined 31 patients with abnormal pulmonary findings twice.
    • Inter- and intraobserver agreement were assessed using kappa statistics.

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  • Findings were compared to those of specially trained pulmonary physicians.

    • Main Results:

    • Examiners were self-consistent in 74-89% of examinations, but disagreed with themselves 11-26% of the time.
    • Pulmonary specialists were less self-consistent (55% of observations) than medical students (74%).
    • Dichotomous variables (wheezes, crackles, rubs) were more reliably detected (kappa = 0.30-0.70) than graded variables (kappa = 0.16-0.43).

    Conclusions:

    • There is significant inter- and intraobserver disagreement in pulmonary examinations.
    • Training alone does not necessarily improve clinical performance consistency.
    • Dichotomous pulmonary findings are more clinically reliable than graded findings.