title: Accuracy of abdominal auscultation for bowel obstruction.
abstract: OBJECTIVE
  To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction.
  
  
  METHODS
  Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic.
  
  
  RESULTS
  Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42 (range: 0.19-0.64) and 0.78 (range: 0.35-0.98), respectively. There was no significant difference in accuracy between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction (26% vs 23%, P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66).
  
  
  CONCLUSIONS
  Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.
authors.affiliation: Birger Michael Breum, Thomas Kirkegaard, Tyge Nordentoft, Department of Surgical Gastroenterology 360, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.
authors.forename: Birger Michael
authors.initials: BM
authors.lastname: Breum
authors.affiliation: Birger Michael Breum, Thomas Kirkegaard, Tyge Nordentoft, Department of Surgical Gastroenterology 360, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.
authors.forename: Bo
authors.initials: B
authors.lastname: Rud
authors.affiliation: Birger Michael Breum, Thomas Kirkegaard, Tyge Nordentoft, Department of Surgical Gastroenterology 360, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kirkegaard
authors.affiliation: Birger Michael Breum, Thomas Kirkegaard, Tyge Nordentoft, Department of Surgical Gastroenterology 360, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.
authors.forename: Tyge
authors.initials: T
authors.lastname: Nordentoft
mesh_terms: D000162:Acoustics; D001307:Auditory Perception; D001314:Auscultation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000601:surgery; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D013018:Sound Spectrography; D019023:Stethoscopes
keywords: Accuracy; Auscultation; Bowel obstruction; Bowel sounds; Diagnostic test; Multi-observer; Observer variation; Prospective