Chest
Clinicai Investigations: CardiologyThe Accuracy and Interobserver Agreement in Detecting the ‘Gallop Sounds’ by Cardiac Auscultation
Section snippets
Study Population
The study was approved by the Sunnybrook Health Sciences Centre Research Ethics Board and all subjects consented to participation. Newly admitted patients to the general internal medicine or cardiology wards were screened for the presence of S4 and/or S3 by nonobserver general internal medicine and subspecialty housestaff and/or staff. The screening process was meant to recruit patients for the study in a limited time period. To ensure that the observers remain blinded, five patients with
Results
The PCG recordings of 41 of the 46 patients were suitable for analysis. Three recordings were lost due to computer malfunction and two were technically inadequate for analysis. Among these 41 patients, the PCG detected 12 S4 and 19 S3. No patient had both S4 and S3. The diagnosis of the 12 patients found to have S4 include 7 with unstable angina/myocardial infarction, 3 with heart failure, and 2 with valvular disease. The diagnosis of the patients with a detectable S3 include 18 with heart
Discussion
The main finding of this study is that the accuracy of identifying S4 and S3 by cardiac auscultation is fair at best. In terms of the accuracy in detecting S4, a mean PPV of 51% and mean NPV of 82% are similar to the results of a previous study of comparable size.20 As might be expected, the PPVs are lower while the NPVs are higher compared with larger studies.21,22
In 1952, Sloan et al23 reported clear disagreement among three investigators in detecting the presence of S3. To our knowledge, the
CONCLUSION
The agreement between observers and the PCG gold standard in the correct identification of S4 and S3 was poor and the lack of agreement did not appear to be a function of the level of training and/or experience of the observers. The overall interobserver agreement for the detection of either S4 or S3 was little better than chance alone.
ACKNOWLEDGMENTS
Special thanks to the following consultants and housestaff for their participation in this study: Drs. F. Ali, P. El-Helou, G. Froggatt, D. Juurlink, R. Myers, S. Shumak, M. Stanbrook, and A. Zahedi. Thanks also to Marko Katic, BA, for his expert statistical assistance, and Drs. C. Lau and D. Naylor for their inspiration and support.
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