Observer variability in the pulmonary examination

Cynthia D. Mulrow, Bart L. Dolmatch, Elizabeth R. Delong, John R. Feussner, Mark C. Benyunes, Joel L. Dietz, Stephen Kenneth Lucas, Etta D. Pisano, Laura P. Svetkey, Brian D. Volpp, Russell E. Ware, Francis A. Neelon

Research output: Contribution to journalArticle

30 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)364-367
Number of pages4
JournalJournal of General Internal Medicine
Volume1
Issue number6
DOIs
StatePublished - Nov 1 1986

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Lung
Medical Students
Physicians
Respiratory Sounds
Students

Keywords

  • observer variability
  • pulmonary examination

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Mulrow, C. D., Dolmatch, B. L., Delong, E. R., Feussner, J. R., Benyunes, M. C., Dietz, J. L., ... Neelon, F. A. (1986). Observer variability in the pulmonary examination. Journal of General Internal Medicine, 1(6), 364-367. https://doi.org/10.1007/BF02596418

Observer variability in the pulmonary examination. / Mulrow, Cynthia D.; Dolmatch, Bart L.; Delong, Elizabeth R.; Feussner, John R.; Benyunes, Mark C.; Dietz, Joel L.; Lucas, Stephen Kenneth; Pisano, Etta D.; Svetkey, Laura P.; Volpp, Brian D.; Ware, Russell E.; Neelon, Francis A.

In: Journal of General Internal Medicine, Vol. 1, No. 6, 01.11.1986, p. 364-367.

Research output: Contribution to journalArticle

Mulrow, CD, Dolmatch, BL, Delong, ER, Feussner, JR, Benyunes, MC, Dietz, JL, Lucas, SK, Pisano, ED, Svetkey, LP, Volpp, BD, Ware, RE & Neelon, FA 1986, 'Observer variability in the pulmonary examination', Journal of General Internal Medicine, vol. 1, no. 6, pp. 364-367. https://doi.org/10.1007/BF02596418
Mulrow CD, Dolmatch BL, Delong ER, Feussner JR, Benyunes MC, Dietz JL et al. Observer variability in the pulmonary examination. Journal of General Internal Medicine. 1986 Nov 1;1(6):364-367. https://doi.org/10.1007/BF02596418
Mulrow, Cynthia D. ; Dolmatch, Bart L. ; Delong, Elizabeth R. ; Feussner, John R. ; Benyunes, Mark C. ; Dietz, Joel L. ; Lucas, Stephen Kenneth ; Pisano, Etta D. ; Svetkey, Laura P. ; Volpp, Brian D. ; Ware, Russell E. ; Neelon, Francis A. / Observer variability in the pulmonary examination. In: Journal of General Internal Medicine. 1986 ; Vol. 1, No. 6. pp. 364-367.
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