Rough data must be mentioned or retrievable. Outcome measures: all data concerning diagnostic accuracy (sensitivity, specificity, positive and negative likelihood ratios (LRs), area under the curve (AUC) and heterogeneity). Target condition: cardiopulmonary edema (refered to congestive heart failure in this meta-analysis), (hemato)pneumothorax, pneumonia, and obstructive lung diseases. Index test: lung auscultation, or lung auscultation as part of the physical examination.Ĭomparator: all studies comparing or evaluating lung auscultation, or lung auscultation as part of the physical examination, with a reference standard mentioned below. Participants: adult patients admitted to all clinical departments of primary or secondary care institution. Time frame: all medical literature published till full search conducted on 19 January 2017. ![]() Study designs: case-control studies, cross-sectional studies, prospective or retrospective observational studies and randomized controlled trials. ![]() The following inclusion criteria were used: The protocol was registered at ‘PROSPERO International prospective register of systematic reviews’ ( ), registration number: CRD42016035312). This is a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to improve the quality of the meta-analysis 7. So, is the stethoscope 200 years after its invention ready to be relegated to a museum shelf or does the stethoscope still provide vital clues to aid in the diagnosis 5, 6? The objective of this meta-analysis is to evaluate the diagnostic accuracy of lung auscultation in various clinical settings for the four most common acute respiratory pathologies: congestive heart failure, (hemato)pneumothorax, pneumonia, and obstructive lung diseases. The question arises if the use of the stethoscope still attributes to further diagnostic work-up or if using the stethoscope is just a waste of time. Despite the fact that the diagnostic accuracy of lung auscultation is widely debated, the stethoscope is still a first line diagnostic tool and used for clinical or therapeutic decision-making. To date, it is still ambiguous how this diagnostic tool contributes to the diagnostic work-up for various pulmonary entities. Nowadays, physicians might not be in the position to spend that amount of time to evaluate chest sounds, potentially leading to an inefficient and superficial examination, giving a delay in further diagnostic work-up and treatment 3, 4. However, detailed auscultation alone can take up to 10 minutes 3. History taking and a detailed physical examination, including auscultation, are considered essential parts of clinical examination. Auscultation of the respiratory system is non-invasive, safe, inexpensive and easy-to-perform. ![]() The use of the stethoscope is considered an essential skill in the medical profession and is often chosen for its’ ease of use, as well as for its’ appearance and reputation 2. Laënnec invented the most common symbol of medicine: the stethoscope 1. Only in resource limited settings, with a high prevalence of disease and in experienced hands, lung auscultation has still a role. When better diagnostic modalities are available, they should replace lung auscultation. Lung auscultation has a low sensitivity in different clinical settings and patient populations, thereby hampering its clinical utility. Results are limited by significant heterogeneity. Abnormal breath sounds are highly specific for (hemato)pneumothorax in patients with trauma. LRs and AUC of auscultation for congestive heart failure, pneumonia and obstructive lung diseases are low, LR− and specificity are acceptable. For 34 studies the overall pooled sensitivity for lung auscultation is 37% and specificity 89%. A meta-regression analysis is performed to reduce observed heterogeneity. 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. ![]() Studies concerning adult patients with respiratory symptoms are included. This meta-analysis aims to evaluate the diagnostic accuracy of lung auscultation for the most common respiratory pathologies. However, there is much debate about the diagnostic accuracy of this instrument. The stethoscope is used as first line diagnostic tool in assessment of patients with pulmonary symptoms.
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