WHO case management algorithm for paediatric pneumonia relies solely on symptoms of shortness of breath or cough and tachypnoea for treatment and has poor diagnostic specificity, tends to increase antibiotic resistance. Alternatives, including oxygen saturation measurement, chest ultrasound and chest auscultation, exist but with potential disadvantages. Electronic auscultation has potential for improved detection of paediatric pneumonia but has yet to be standardised. The authors aim to investigate the use of electronic auscultation to improve the specificity of the current WHO algorithm in developing countries.
This study is designed to test the hypothesis that pulmonary pathology can be differentiated from normal using computerised lung sound analysis (CLSA). The authors will record lung sounds from 600 children aged ≤5 years, 100 each with consolidative pneumonia, diffuse interstitial pneumonia, asthma, bronchiolitis, upper respiratory infections and normal lungs at a children's hospital in Lima, Peru. The authors will compare CLSA with the WHO algorithm and other detection approaches, including physical exam findings, chest ultrasound and microbiologic testing to construct an improved algorithm for pneumonia diagnosis.
This study will develop standardised methods for electronic auscultation and chest ultrasound and compare their utility for detection of pneumonia to standard approaches. Utilising signal processing techniques, the authors aim to characterise lung sounds and through machine learning, develop a classification system to distinguish pathologic sounds. Data will allow a better understanding of the benefits and limitations of novel diagnostic techniques in paediatric pneumonia.
We seek to characterise lung sounds associated with different respiratory illnesses in children using electronic auscultation and determine whether these sounds can be differentiated from normal through computerised lung sound analysis.
We summarise the study design and methods with standardised protocols for electronic auscultation and chest ultrasound in children.
We aim to develop a protocol for increased specificity of paediatric pneumonia diagnosis in developing countries.
Strengths and limitations of this study
Our study is limited by the case definitions available. With no gold standard for many paediatric respiratory diseases, we will rely on clinical exam findings and chest radiography.
By investigating a number of novel and commonly used diagnostic tools for a variety of respiratory diseases in children, we will gain valuable information regarding the diagnostic potential of each, with a main focus on the electronic stethoscope.