Reevaluating Auscultation Techniques in Pediatric Pneumonia: Are My Ears Misleading Me?

By
Susan C. Lipsett
Mark I. Neuman
August 20, 2026

Jama Network Open

Objective:

To investigate the interrater reliability of physical examination findings in children diagnosed with community-acquired pneumonia.

Approach:

Study Design: Secondary analysis of a prospective cohort study involving 252 youths diagnosed with community-acquired pneumonia across seven academic pediatric emergency departments.
Data Collection: Two emergency department clinicians examined each patient within a 60-minute interval and filled out a standardized form regarding various physical examination findings.

Key Findings:

Wheezing and retractions showed the highest interrater agreement (κ = 0.50 and 0.49, respectively), but no finding met the criteria for acceptable reliability.
Crackles and decreased breath sounds had κ values below 0.25, indicating poor agreement.
The variability in auscultatory findings undermines their effectiveness as diagnostic indicators.

Interpretation:

The lack of consensus on auscultatory findings may lead to variability in treatment decisions and antibiotic prescribing practices, as clinicians may overestimate the importance of these findings.

Limitations:

Insufficient power to detect age-related differences in findings.
Variability in terminology usage among clinicians may affect agreement.
The study design may have led to artificially inflated or lowered levels of agreement.

Conclusion:

Integrating objective risk-stratification instruments into clinical practice may improve diagnostic consistency and reduce reliance on subjective auscultatory interpretation.