@poster{McCollum2017a,
<br>abstract = {Introduction: Despite enormous potential, chest auscultation has contributed little to pediatric pneumonia care in developing countries to date. World Health Organization (WHO) child pneumonia management algorithms for frontline health workers have prioritized clinical signs, such as respiratory rate and chest indrawing, that are easier to teach, have greater agreement between providers, and are believed to have stronger associations with health outcomes than lung sounds. By enabling more systematic interpretation of lung sounds through recordings interpreted by humans or computers, digital stethoscopes may overcome these perceived drawbacks. As part of The Pneumonia Etiology Research for Child Health (PERCH) project we sought to evaluate whether lung sounds that were digitally recorded and interpreted by humans were associated with treatment outcomes among children with pneumonia. Methods: At study enrollment PERCH staff used digital stethoscopes to record lung sounds from a subset of children 1-59 months old with WHO severe or very severe pneumonia in Bangladesh, Gambia, Kenya, South Africa, Thailand, and Zambia. Pneumonia was managed according to local guidelines and children were followed until 30 days or an outcome was determined, whichever occurred earlier. A physician listening panel, trained to follow a standardized protocol, assigned each subject a summary lung sound classification. Interpretable classifications were re-categorized into dichotomous groupings: any crackle, crackle only, any wheeze, or wheeze only. We used case fatality ratios (CFRs) stratified into risk categories, and multivariate logistic regression, using pneumonia cases with normal lung sounds as the reference and controlling for region and selected risk factors, to evaluate the association between recorded lung sounds and mortality. Results: Six hundred eighteen of 792 (78.0{\%}) children had interpretable recordings and a 30-day outcome. Participant mean age was 12.2 months and most were male (357/618, 58.7{\%}), from African study sites (414/618, 66.9{\%}), and classified with severe pneumonia (403/618, 65.2{\%}); 11.2{\%} (69/618) of children died within 30 days of enrollment. Risk stratified CFRs are presented in the table. Wheezing, with or without crackles, was associated with an odds ratio for death of 0.41 (95{\%} confidence interval 0.23, 0.72) in univariate analysis. Lung sounds were not associated with mortality in multivariate models. Conclusions: Although digitally recorded lung sounds were not independently associated with mortality in PERCH, wheezing was associated with lower odds of mortality in univariate analysis and with lower CFRs, most notably in lower risk strata. Digitally recorded wheeze may have future clinical application among selected children with WHO pneumonia in developing countries.},
<br>author = {McCollum, E and Park, D and Watson, N and Focht, C and Bunthi, C and Ebruke, B and Elhilali, M and Emmnouilidou, D and Hossain, L and Moore, D and Mudaua, A and Mulindwa, J and West, J and O'Brien, K and Feikin, D and Hammitt, L},
<br>booktitle = {International American Thoracic Society meeting},
<br>title = {{Digitally-recorded lung sounds and mortality among children 1-59 months old with pneumonia in the Pneumonia Etiology research for Child Health study}},
<br>url = {https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2017.195.1{\_}MeetingAbstracts.A1195},
<br>year = {2017}
<br>}