Observer variability in the pulmonary examination
- 60 Downloads
- 20 Citations
Abstract
Observer variability in the pulmonary examination was assessed by having four blindfolded observers (two medical students and two pulmonary physicians) twice examine 31 patients with abnormal pulmonary findings. Examiners were consistent in the repetitive detection of pulmonary abnormalities in 74–89% of the examinations; conversely, 11–26% of the time they disagreed with themselves. Although pulmonary specialists recorded fewer (55% of observations) abnormal findings than did medical students (74%), they were significantly (p=0.008) less self-consistent than were the students. There was no clear trend in agreement between examiners (kappa=0.20−0.49). Each examiner’s findings were compared with those of physicians specially trained in pulmonary examination. Dichotomous variables (wheezes, crackles, rubs) were more reliably detected (kappa=0.30−0.70) than graded variables (tympany, dullness, breath sound intensity), where kappa=0.16−0.43. The authors suggest that dichotomous variables deserve greatest clinical reliance; that time in training, alone, does not improve clinical performance; and that there is a disconcertingly large amount of inter- and intraobserver disagreement in this fundamental clinical task.
Key words
observer variability pulmonary examinationPreview
Unable to display preview. Download preview PDF.
References
- 1.Keen WW. Quoted in: Lewiston M, Freilich EB. Manual of physical diagnosis with special consideration of the heart and lung. Chicago: Year Book Publishing Company, 1941Google Scholar
- 2.Schneider IC, Anderson AE. Correlation of clinical signs with ventilatory function in obstructive lung disease. Ann Intern Med 1965;62:477–85CrossRefPubMedGoogle Scholar
- 3.Pyke DA. Variability in detecting clubbing. Lancet 1954;2:352–3CrossRefGoogle Scholar
- 4.Godfrey S, Edwards RHT, Campbeil EJM, Armitage P, Oppenheimer EA. Repeatability of physical signs in airway obstruction. Thorax 1969;24:4–9CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Smyllie HC, Blendis LM, Armitage P. Observer disagreement in physical signs of the respiratory system. Lancet 1965;2:412–3CrossRefPubMedGoogle Scholar
- 6.Gjorup T, Bugge PM, Jensen AM. Interobserver variation in assessment of respiratory signs. Acta Med Scand 1984;216:61–6CrossRefGoogle Scholar
- 7.Fletcher CM. The clinical diagnosis of pulmonary emphysema — an experimental study. Proc R Soc Med 1952;45:577–84PubMedGoogle Scholar
- 8.The ACCP-ATS Joint Committee on Pulmonary Nomenclature: Pulmonary terms and symbols. Chest 1975;67:583–93CrossRefGoogle Scholar
- 9.The ATS Ad Hoc Committee on Pulmonary Nomenclature: Updated nomenclature for membership reaction. ATS News 1977;5–6Google Scholar
- 10.Koch GG, Landis JR, Freeman JL, Freeman DH. A general methodology for the analysis of experiments with repeated measurement of categorical data. Biometrics 1977;33:133–58CrossRefPubMedGoogle Scholar
- 11.Landis JR, Koch GG. An application of hierarchial kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977;33:363–74CrossRefPubMedGoogle Scholar
- 12.Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–74CrossRefPubMedGoogle Scholar
- 13.Dolmatch BL, Ware RE, Ackerman R. Prediction of pulmonary disease using clinical lung findings. Clin Res 1982;30:837AGoogle Scholar