Dokument

Zusammenfassung:
Atemnot und Husten sind quälende Symptome, welche bei einer Vielzahl von Erkrankungen auftreten und die Lebensqualität deutlich beeinträchtigen. Gerade nachts sind diese Symptome jedoch nur schwer erfassbar. Mit Hilfe des Lung Sound Monitorings gelingt eine zuverlässige Aufzeichnung von nächtlichen akustischen Symptomen. Die Analyse der Messdaten erfolgt durch erfahrene Untersucher anhand eines standardisierten Bewertungsschemas. Ziel dieser Arbeit ist es, Parameter dieses Schemas auf Reliabilität und Beobachterkonkordanz zu überprüfen. Hierfür wurden aus der MARS-Datenbank insgesamt 36 Segmente von neun verschiedenen Patienten ausgesucht und in zwei Bewertungsdurchgänge (Testsets) randomisiert. Acht Studienteilnehmer bewerteten diese Segmente nach einer Schulungsveranstaltung. Reliabilität und Beobachterkonkordanz wurden für Parameter mit nominalem Skalenniveau anhand des Kappa- Koeffizienten (k) und für ordinal verteilte Daten mittels des Spearman-Brown- Koeffizienten (Spearmans Rho, r) berechnet. Der Parameter Wheezingrate (tWheez/tTot) ist reliabel (r = 0,858 [Minimum 0,693 - Maximum 0,937]) und valide (r = 0,747 [0,571 - 0,859]), ebenso der Parameter Hustenzahl (Hustenereignisse pro Zeiteinheit, Reliabilität r = 0,992 [0,909-0,999]; Beobachterkonkordanz r = 0,994 [0,923 - 0,999]) und Hustenrate (tCough/tTot, Reliabilität r = 0,972 [0,909 - 0,999]; Beobachterkonkordanz r = 0,964 [0,860 - 0,997]). Lediglich der Parameter Hustenart (Reliabilität k = 0,100 [-0,161 - 0,476]; Beobachterkonkordanz k = - 0,043 [-0,391 - 0,244]) zeigte eine nur zufällig häufige Übereinstimmung. Hustenrate und Hustenzahl stehen in einem eindeutigen linearen Zusammenhang (p<0,01). Die mittlere Hustendauer wurde mit 2,77 Sekunden berechnet. Anhand dieser Ergebnisse wurde das Bewertungsschema weiterentwickelt. Es dient als Grundlage für das Erstellen einer Referenzatenbank. Mithilfe dieser werden Algorithmen zur Erfassung von nächtlichen akustischen Symptomen entwickelt und erprobt.

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