Variation in family physicians’ recording of auscultation abnormalities in patients with acute cough is not explained by case mix. A study from 12 European networks

Abstract

Background: Conflicting data on the diagnostic and prognostic value of auscultation abnormalities may be partly explained by inconsistent use of terminology.

Objectives: To describe general practitioners use of chest auscultation abnormality terms for patients presenting with acute cough across Europe, and to explore the influence of geographic location and case mix on use of these terms.

Methods: Clinicians recorded whether ‘diminished vesicular breathing’, ‘wheezes’, ‘crackles’ and ‘rhonchi’ were present in an observational study of adults with acute cough in 13 networks in 12 European countries. We describe the use of these terms overall and by network, and used multilevel logistic regression to explore variation by network, controlling for patients’ gender, age, comorbidities, smoking status and symptoms.

Results: 2345 patients were included. Wheeze was the auscultation abnormality most frequently recorded (20.6% overall) with wide variation by network (range: 8.3–30.8%). There was similar variation for other auscultation abnormalities. After controlling for patient characteristics, network was a significant predictor of auscultation abnormalities with odds ratios for location effects ranging from 0.37 to 4.46 for any recorded auscultation abnormality, and from 0.25 to 3.14 for rhonchi.

Conclusion: There is important variation in recording chest auscultation abnormalities by general practitioners across Europe, which cannot be explained by differences in patient characteristics. There is a need and opportunity for standardization in the detection and classification of lung sounds.

Keywords::

• Lower respiratory tract infection
• auscultation
• cough
• wheeze
• rhonchi
• crackles

ACKNOWLEDGEMENTS

The authors should like to thank all patients, clinicians, and networks that participated in the GRACE-01 study. The authors acknowledge the entire GRACE team for their expertise, hard work, and enthusiasm. The GRACE study was funded by the 6th Framework Programme of the European Commission.

Funding

This work was supported by the 6th Framework Programme of the European Commission (reference: LSHM–CT–2005–518226) and the South East Wales Trials Unit is funded by the Wales Office for Research and Development. The Antwerp Primary Care Network was supported by the Research Foundation—Flanders (G.0274.08N).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.