Each participating doctor received a personal log-on to the website and the sound files were arranged in a randomized order unique to the log-on. A website was designed (English version available at ) where the participating doctors accessed and evaluated the bowel sounds. Consultants and senior registrars were considered seniors. In order to evaluate the impact of experience, doctors were divided into junior and senior groups. The aim of this study was to investigate the accuracy and inter-observer agreement for bowel sound assessment in patients suspected of intestinal obstruction.įollowing acquisition of this data, all doctors working in the department from November 2007 to November 2008 were invited to evaluate the bowel sounds as described below. Had abdominal auscultation not been such a cheap investigation, it would probably not have survived for more than 150 years-given the very limited documentation of its clinical value. Hence, previous studies have demonstrated low to moderate inter-observer agreement for bowel sound assessment. In clinical practice, the description and assessment of bowel sounds is often vague and inconclusive. However, these studies did not assess the influence of observer variation in bowel sound assessments. Two prospective studies in patients with acute abdominal pain found that increased or abnormal bowel sounds were independent markers of bowel obstruction. Contemporary textbooks often state that hyperactive, tinkling, metallic or high-pitched bowel sounds are characteristic clinical findings in patients with bowel obstruction, but the evidence supporting the clinical utility of these findings is sparse. Auscultation of bowel sounds is a quick and low-cost examination, and has been used for more than 150 years to assess various abdominal conditions. Because of the need for prompt and reliable assessment of patients suspected of having bowel obstruction, clinicians must know which components to focus on in the history and the physical examination. Early diagnosis and treatment of bowel obstruction are imperative in reducing these risks. The risk of complications of bowel obstruction such as intestinal strangulation, necrosis and perforation are reported to be as high as 5%-16%. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.īowel obstruction is a common emergency condition in abdominal surgery. The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66).ĬONCLUSION: Accuracy and inter-observer agreement was generally low. 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). There was no significant difference in accuracy between junior and senior doctors. Two patients underwent colorectal stenting due to large bowel obstruction. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. RESULTS: Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. ![]() Interobserver variation was measured using the Kappa statistic. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. ![]() ![]() The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. ![]() Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The recordings were processed to yield 25-s sound sequences in random order on PCs. METHODS: Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann ® Electronic Stethoscope. AIM: To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction.
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