A national study finds significant inconsistency among doctors when interpreting lung sounds in children suspected of pediatric pneumonia.


RT’s Three Key Takeaways:

  1. Diagnostic Inconsistency: Researchers found that doctors often disagreed about common lung sounds used to help diagnose pneumonia, including crackles, decreased breath sounds, and rhonchi.
  2. Physical Exam Limitations: The study suggests that a physical exam alone may not always provide enough information to confidently diagnose pneumonia in pediatric patients.
  3. Need for Objective Tools: The findings highlight a need for more objective diagnostic tools, such as electronic stethoscopes, computer programs that analyze sounds, or improved imaging techniques.


Doctors may not always hear or interpret the same things when examining the same child for pneumonia, according to a national study published in JAMA Network Open.

The study, led by physician-scientists at Children’s Hospital of Chicago and the Pediatric Emergency Care Applied Research Network (PECARN), illustrates the limitations of the physical examination in clinical settings by showing that doctors often disagreed about common lung sounds, including crackles and rhonchi.

“Doctors rely heavily on what they hear when listening to a child’s lungs, but our study shows that two doctors can examine the same child and come away with different findings,” said Todd Florin, MD, MSCE, associate division head for Academic Affairs and research and attending physician, Emergency Medicine. “This can make diagnosing pneumonia challenging and points to the need for better tools to help us make these decisions.”

Pneumonia is one of the most common respiratory infections in children, leading to nearly 2 million outpatient visits and 375,000 emergency department visits each year in the US. Current guidelines recommend that healthcare providers diagnose pneumonia based on symptoms and a physical exam, without routinely using a chest X-ray, when children are otherwise healthy.

Researchers examined 252 children ages 3 months to 17 years who were diagnosed with pneumonia at one of seven pediatric emergency departments across the country. Each child was examined by two doctors within an hour of each other, with each physician independently recording their findings.

The study found that several findings traditionally considered important—such as decreased breath sounds and crackles—were identified inconsistently between providers. While wheezing and signs of increased work of breathing were more consistently identified, they still did not meet the study standard for strong agreement.

“The results showed that several findings traditionally considered important—such as decreased breath sounds and crackles—were identified inconsistently between emergency department providers,” said Shubhada Hooli, MD, MPH, assistant professor of Pediatrics at Baylor College of Medicine.

Accurate diagnosis is critical because about two-thirds of children with community-acquired pneumonia experience side effects from antibiotics. Improved identification methods could help healthcare providers determine which children truly benefit from antibiotic treatment and which do not.

The researchers suggested that more objective tools could eventually help healthcare providers make more consistent diagnoses. These could include electronic stethoscopes that record lung sounds, computer programs that analyze those sounds, improved imaging techniques, and blood tests that look for signs of pneumonia.

“A stethoscope will continue to be an important tool for doctors,” said Florin. “But we need to find ways to make the diagnosis of pneumonia more accurate and consistent. Better tools could help us avoid unnecessary antibiotics while making sure children who truly have pneumonia get the treatment they need.”