1. Identification of the auscultatory landmarks in SMA patients
and concordance with the standard landmarks
The identification of landmarks using a traditional stethoscope showed
high concordance between examiners (100%), ICC= 1. The landmarks
identified through clinical auscultation using a traditional stethoscope
and lung ultrasound assessment also had high concordance (100%) in all
patients, irrespective of their scoliosis or chest deformities. Lung
vertical artifacts, sub-pleuric consolidation and small atelectasis were
quite common US findings, as confirmed by literature but did not
interfere with lung auscultation. This allowed to draw a lung
auscultation map for each patient with 8 different sites, 4 on the back
and 4 on the front, with children-friendly an-allergic colored stickers,
placed directly on the children’s body (Fig. 2, Fig. 3). Parents were
encouraged to take as many pictures as they wanted for future
independent evaluations.
The landmarks identified through auscultation and LUS were identical to
the standard landmarks provided by the device in 7 of the 23 (30%), in
another 8 (35%) were located in proximity to the standard ones (within
2 to 5 cm circular area) while in the remaining 8 (35%) resulted in
completely different areas.
The concordance between personalized auscultatory and standard landmarks
was higher in the non-sitters, i-e the children with the most severe
phenotypes who can be only assessed in the supine position and can be
postured to at least partially correct scoliosis, when present (table
1). The concordance was much lower in children with Cobb>
50° and chest deformities irrespective of the SMA type.