Doctors Often Disagree on Lung Sounds When Diagnosing Child Pneumonia, Study Finds

A national study led by physician-scientists at Ann & Robert H. Lurie Children's Hospital of Chicago and the Pediatric Emergency Care Applied Research Network (PECARN) has found that doctors often disagree about the lung sounds they hear when examining children for pneumonia, a lung infection causing nearly 2 million outpatient visits and 375,000 emergency-department visits in the US each year. Current guidelines recommend diagnosing pneumonia in healthy children from symptoms and a physical exam alone, without routinely ordering a chest X-ray.

The study, published August 20 in JAMA Network Open, examined 252 children aged 3 months to 17 years diagnosed with pneumonia at seven pediatric emergency departments nationwide. Each child was examined by two doctors within an hour of each other, who recorded findings independently. Common lung sounds used to identify pneumonia - crackles, decreased breath sounds and rhonchi - were not consistently recognised by both doctors. Wheezing and signs of harder breathing were identified more consistently, but still fell short of the study's standard for strong agreement.

"Doctors rely heavily on what they hear when listening to a child's lungs, but our study shows that two doctors can examine the same child and come away with different findings," said the study's principal investigator, Dr. Todd Florin of Lurie Children's and Northwestern University Feinberg School of Medicine. "This can make diagnosing pneumonia challenging and points to the need for better tools to help us make these decisions."

Accurately diagnosing pneumonia matters because a wrong diagnosis can mean a child receives treatment they do not need, or misses treatment they do need; about two-thirds of children with community-acquired pneumonia experience antibiotic side effects, the study notes. More objective tools, such as electronic stethoscopes, sound-analysing software, improved imaging and blood tests, could eventually help doctors diagnose more consistently, the researchers say.

"A stethoscope will continue to be an important tool for doctors," Florin said, "but we need to find ways to make the diagnosis of pneumonia more accurate and consistent."