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.