INTRODUCED NEARLY 200 years ago, auscultation and percussion of the chest are considered essential in the physical examination and are taught to every medical student. The traditional chest physical examination is not sufficiently accurate on its own to confirm or exclude the diagnosis of pneumonia. The most valuable examination maneuvers in detecting pneumonia were unilateral rales and rales in the lateral decubitus position. The 3 examiners' clinical diagnosis of pneumonia had a sensitivity of 47% to 69% and specificity of 58% to 75%.Ĭonclusions The degree of interobserver agreement was highly variable for different physical examination findings. Relatively high agreement among examiners (κ ≈ 0.5) occurred for rales in the lateral decubitus position and for wheezes. Abnormal lung sounds were common in both groups the most frequently detected were rales in the upright seated position and bronchial breath sounds. Twenty-eight patients did not have pneumonia. Results Twenty-four patients had pneumonia confirmed by chest x-ray films. Chest x-ray films were read by a radiologist. Examination findings by lung site and whether the examiner diagnosed pneumonia were recorded on a standard form.

A comprehensive lung physical examination was performed sequentially by 3 physicians who were blind to clinical history, laboratory findings, and x-ray results. Methods Fifty-two male patients presenting to the emergency department of a university-affiliated Veterans Affairs medical center with symptoms of lower respiratory tract infection (cough and change in sputum) were prospectively examined. Objectives To determine the accuracy of various physical examination maneuvers in diagnosing pneumonia and to compare the interobserver reliability of the maneuvers among 3 examiners. Shared Decision Making and Communicationīackground The reliability of chest physical examination and the degree of agreement among examiners in diagnosing pneumonia based on these findings are largely unknown.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.

Lung sounds rales