title: Abdominal auscultation does not provide clear clinical diagnoses.
abstract: BACKGROUND
  Abdominal auscultation is a part of the clinical examination of patients, but the determining factors in bowel sound evaluation are poorly described. The aim of this study was to assess inter- and intra-observer agreement in physicians' evaluation of pitch, intensity and quantity in abdominal auscultation.
  
  
  METHODS
  A total of 100 physicians were presented with 20 bowel sound recordings in a blinded set-up. Recordings had been made in a mix of healthy volunteers and emergency patients. They evaluated pitch, intensity and quantity of bowel sounds in a questionnaire with three, three and four categories of answers, respectively. Fleiss' multi-rater kappa (κ) coefficients were calculated for inter-observer agreement; for intra-observer agreement, calculation of probability was performed.
  
  
  RESULTS
  Inter-observer agreement regarding pitch, intensity and quantity yielded κ-values of 0.19 (p < 0.0001), 0.30 (p < 0.0001) and 0.24 (p < 0.0001), respectively, corresponding to slight, fair and fair agreement. Regarding intra-observer agreement, the probability of agreement was 0.55 (95% confidence interval (CI): 0.51-0.59), 0.45 (95% CI: 0.42-0.49) and 0.41 (95% CI: 0.38-0.45) for pitch, intensity and quantity, respectively.
  
  
  CONCLUSIONS
  Although relatively poor, observer agreement was slight to fair and thus better than expected by chance. Since the diagnostic value of auscultation increases with addition of history and clinics, and may be further improved by systematic training, it should still be used in the examination of patients with acute abdominal pain.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Hjerte-, lunge- karkirurgisk Afdeling, Aarhus Universitetshospital, 8200 Aarhus N, Denmark. majadickenson@gmail.com
authors.forename: Maja
authors.initials: M
authors.lastname: Durup-Dickenson
authors.forename: Marie Kirk
authors.initials: MK
authors.lastname: Christensen
authors.forename: John
authors.initials: J
authors.lastname: Gade
mesh_terms: D000005:Abdomen; D001314:Auscultation; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D007422:Intestines / Q000503:physiopathology*; D008144:Loudness Perception; D015588:Observer Variation; D010897:Pitch Discrimination; D013016:Sound