The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis
The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis
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DOI：
10.1038/s41598-020-64405-6
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发表时间：
2020-04-30
影响因子：
4.6
通讯作者：
Tuinman, Pieter R.
中科院分区：
文献类型：
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作者：
Arts, Luca;Lim, Endry Hartono Taslim;Tuinman, Pieter R.
听诊器被用作评估肺部症状患者的一线诊断工具。然而，关于该仪器的诊断准确性存在很多争论。本荟萃分析旨在评估肺听诊对最常见呼吸系统疾病的诊断准确性。包括有呼吸道症状的成年患者的研究。主要结果是对不同肺部病理和呼吸音的肺听诊的敏感性和特异性（95%置信区间）、似然比（LRs）、曲线下面积（AUC）的合并估计。进行meta回归分析以减少观察到的异质性。在34项研究中，肺听诊的总体敏感性为37%，特异性为89%。充血性心力衰竭、肺炎和阻塞性肺疾病的听诊LRs和AUC较低，LR和特异性可接受。异常的呼吸音是创伤性气胸患者所特有的。结果受到显著异质性的限制。肺听诊在不同的临床环境和患者群体中具有较低的敏感性，从而阻碍了其临床应用。当有更好的诊断方式可用时，它们应取代肺听诊。只有在资源有限的情况下，在疾病高流行和经验丰富的情况下，肺听诊仍然发挥作用。
The stethoscope is used as first line diagnostic tool in assessment of patients with pulmonary symptoms. However, there is much debate about the diagnostic accuracy of this instrument. This meta-analysis aims to evaluate the diagnostic accuracy of lung auscultation for the most common respiratory pathologies. Studies concerning adult patients with respiratory symptoms are included. Main outcomes are pooled estimates of sensitivity and specificity with 95% confidence intervals, likelihood ratios (LRs), area under the curve (AUC) of lung auscultation for different pulmonary pathologies and breath sounds. A meta-regression analysis is performed to reduce observed heterogeneity. For 34 studies the overall pooled sensitivity for lung auscultation is 37% and specificity 89%. LRs and AUC of auscultation for congestive heart failure, pneumonia and obstructive lung diseases are low, LR- and specificity are acceptable. Abnormal breath sounds are highly specific for (hemato)pneumothorax in patients with trauma. Results are limited by significant heterogeneity. Lung auscultation has a low sensitivity in different clinical settings and patient populations, thereby hampering its clinical utility. When better diagnostic modalities are available, they should replace lung auscultation. Only in resource limited settings, with a high prevalence of disease and in experienced hands, lung auscultation has still a role.