Diagnostic value of lung auscultation in an emergency room setting.
BACKGROUND
In daily routine, physicians use history, physical examination and technology-based information such as laboratory tests and imaging studies to diagnose the patients' disease. We determined the diagnostic value of lung auscultation in patients admitted to the Medical emergency room with chest symptoms.


METHODS
Two-hundred-and forty-three consecutive patients (137 males), mean age 59.2 years were included. Internal Medicine registrars had to make a presumptive diagnosis, 1) after having taken the history and 2) after having auscultated the lungs. Thereafter, routine diagnostic procedures were performed. The estimated diagnosis was compared with the final diagnosis based on the written report to the Family Practitioner.


RESULTS
Two-hundred-eighty-seven diagnoses were made. Eighteen percent of patients suffered from left heart failure, 13% from unexplained chest pain, 10.5% from chest wall pain, and 10.5% from pneumonia. Forty-one percent of the diagnoses were already correct when based only on the patient's history. Lung auscultation improved the diagnostic yield only in 1% and worsened it in another 3%. By multiple logistic regression, normal lung auscultation (OR 0.12 [95CI% 0.053-0.29]) was the independent predictor for not having a lung or heart disease. However, elevation of B-type natiuretic peptide (BNP) (OR 1.16 per 100 pg/ml (95CI% 1.004-1.35), wheezing (OR 0.023 [0.002-0.33]) and pCO2 (OR 0.25 (0.10-0.621) were independent predictors for having a heart disease, whereas wheezing (OR 7.41 [3.26-16.83]) and CRP (OR 1.008 per 10 units [1.003-1.014]) were risk factors for having a lung disease.


CONCLUSIONS
In contrast to history taking, abnormal lung auscultation does not appear to contribute considerably to the final diagnosis in patients presenting with chest symptoms in an emergency room setting. However, normal lung auscultation is a valuable predictor for not having a lung or heart disease, whereas wheezing is a predictor for having a lung disease and not having a heart disease.
Leuppi
Jörg D
JD
Pneumology, Department of Internal Medicine, University Hospital Basel, Switzerland. jleuppi@uhbs.ch
Dieterle
Thomas
T
Koch
Gian
G
Martina
Benedict
B
Tamm
Michael
M
Perruchoud
André P
AP
Wildeisen
Irène
I
Leimenstoll
Bernd M
BM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001314:Auscultation; D004630:Emergencies; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012135:Respiratory Sounds / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D016037:Single-Blind Method