Wheeze detection: Recordings vs. assessment of physician and parent

Background. Parental and professional agreement as to the presence of wheezing in infants and preschool children has been shown to be poor. Agreement on the absence or presence of physical signs on chest examination in these populations is far from perfect, even among experienced physicians. Objectives. We sought to compare the assessment of a parent, nurse, and physician with the "gold standard" of acoustic analysis for the presence of wheezing in infants and preschool children attending a hospital clinic. Setting and Subjects. Urban district general hospital in North London, England. Wheezy children under 6 years old attending a "walk-in" emergency pediatric ambulatory care unit. Results. Comparisions were completed on 31 children (age range 4-62 months). The severity of wheeze was independently evaluated by a parent, nurse, and experienced pediatrician, and these were compared with breath sounds recorded and analyzed by acoustic techniques for the presence and severity of wheezing. In only 10 of 31 (32%) children did the parent and the physician agree on the wheeze severity score. In 13 infants, the parent scored higher than the doctor and in 8 the parent scored lower. In 16 (52%) of the children, there was complete agreement as to the severity of wheezing by the nurse and the physician. In 24 of the 31 children (77%), the acoustic wheeze score agreed with the physician wheeze score; in 6 children the acoustic score was lower and in 1 it was higher. Conclusions. The physician was able reliably to judge the severity of wheeze measured objectively, whereas nurses and parents were not. This study has important implications for the interpretation of parental questionnaire studies of asthma prevalence and severity.