Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2015; 21(34): 10018-10024
Published online Sep 14, 2015. doi: 10.3748/wjg.v21.i34.10018
Accuracy of abdominal auscultation for bowel obstruction
Birger Michael Breum, Bo Rud, Thomas Kirkegaard, Tyge Nordentoft
Birger Michael Breum, Thomas Kirkegaard, Tyge Nordentoft, Department of Surgical Gastroenterology 360, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark
Bo Rud, Department of Surgery K, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark
Author contributions: Nordentoft T conceived the original idea; Breum BM designed research and programming; Breum BM, Kirkegaard T and Nordentoft T performed research; Rud B analyzed data; Breum BM, Rud B and Nordentoft T wrote the paper; Breum BM, Rud B, Kirkegaard T and Nordentoft T all revised and approved the paper.
Institutional review board statement: The study design was presented to the local research ethics committee before study start. The committee did not consider a formal assessment procedure necessary.
Clinical trial registration statement: Not an intervention study, no registration needed at the time.
Informed consent statement: Verbal informed consent was obtained from patients prior to inclusion.
Conflict-of-interest statement: None.
Data sharing statement: No additional data available, except raw data. Consent was not obtained for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Birger Michael Breum, MD, Department of Surgical Gastroenterology 360, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark. articles@breum.dk
Telephone: +45-38-622108 Fax: +45-38-623797
Received: October 5, 2014
Peer-review started: October 6, 2014
First decision: October 29, 2014
Revised: March 16, 2015
Accepted: April 9, 2015
Article in press: April 9, 2015
Published online: September 14, 2015
Abstract

AIM: To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction.

METHODS: Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann® Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic.

RESULTS: Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42 (range: 0.19-0.64) and 0.78 (range: 0.35-0.98), respectively. There was no significant difference in accuracy between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction (26% vs 23%, P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66).

CONCLUSION: Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.

Keywords: Bowel obstruction, Auscultation, Bowel sounds, Diagnostic test, Accuracy, Observer variation, Multi-observer, Prospective

Core tip: Abdominal auscultation is often used in clinical practice when bowel obstruction is suspected; the usefulness is poorly documented. Early diagnosis and treatment of bowel obstruction is imperative to reduce the risk of intestinal strangulation, necrosis and perforation. Clinicians must know which components to focus on in the physical examination. The present study shows a generally low accuracy and inter-observer agreement when recorded bowel sounds from 98 patients were assessed by 53 doctors. No difference in accuracy was observed between junior and senior doctors. Clinical decisions in patients with possible bowel obstruction should not depend on auscultatory assessment of bowel sounds.