Family doctor takes it through its paces
It’s dubbed as being one of their most advanced stethoscopes yet and with a hefty price tag upwards of $700 AUD, it is worth the fuss? Read on for my in depth and real world review.
The Littmann Core Digital stethoscope has an abundance of features including, amplification of sounds up to 40 times, the ability to record heart sounds on to your mobile device and with a monthly subscription, the ability to detect murmurs in heart sounds using AI.
So let’s take a look at these features and see if it lives up to its hype.
Aesthetics
The stethoscope itself presents as a sleek, chic yet sturdy piece of medical technology. Whilst the tubing always remains black you can add a little colour to the chest piece upon ordering. This for me, however, is some what of a negative, I usually like to have children friendly colours for my medical equipment which helps to act as a distraction for young ones. As anyone who has worked with children before, it can at times, be challenging examining them let alone with a potentially unfriendly looking device. However, it may be that Littmann change this in due course.
The stethoscope has its electronic hub close to the chest piece and this seamlessly transitions from the tubing. Within the hub is a toggle — to switch between analog and digital sounds, a USB charge point/ headphone jack and volume buttons. The addition of the electrical hub does make the stethoscope slightly heavier than my existing stethoscope which is the Littmann Classic III.
On the website the ear pieces are described as being ‘soft sealing’. After using the stethoscope for about two weeks, I would disagree with this. Of course, everyone has different ears, but for me personally, the ear pieces felt harder and more uncomfortable compared to my current stethoscope. Naturally, this could be changed out for different ear pieces, depending on your own preference.
With regards to the length of the stethoscope, it was slightly shorter than my Littmann Classic III which made wearing it around the neck look elegant.
Sounds
The most talked about feature of this stethoscope is the sound. Boasting up to 40x amplification I was very excited to try this out. This would be a particularly useful feature if you were hard of hearing or were working on a noisy ward. Similarly, the active noise cancellation would also help with this.
Before I got into testing the digital aspect, I wanted to see how the analog aspect worked in comparison to my current stethoscope. When listening to the heart sounds with the Core Digital, the heart sounds were much quieter than the Littmann Classic III. Although slightly disappointed by this, I could understand why the manufacturer would perhaps do this as it encourages you to use the main feature of the stethoscope instead. However, just say, one day your charge ran out and you were stuck with the analog sounds, you may be a little dissapointed.
Once the toggle was switched on to activate the digital component, the stethoscope did a 180. Active noise cancellation worked well (although not as good as some high end headphones). Heart sounds were much clearer and louder. Naturally, I cranked up the volume to 40x amplification and for me, it simply didn’t live up to my expectations. Granted the heart sounds were amplified, but then, so was everything else. Added noises, muffling and movements became too loud and swallowed up the heart sounds that I wanted to hear.
So I reduced the amplification down to about half way and there was my happy medium. It submerged me into a world of focus and dedication, heart sounds were pure and crisp, noise cancellation worked a treat and before I knew it I was lost in awe of the stethoscope. One thing that did happen to me whilst I was auscultating and playing around with the volume buttons was that I did accidentally toggle the digital aspect off. This took me out of my focus abruptly and probably with more experience of the stethoscope I wouldn’t do this again.
Additionally, the Core Digital also has a tunable chest piece allowing you to listen to high and low frequency sounds for both adults and children using the diaphragm without having to turn the chest piece.
Once I was satisfied with my amplification level, I took look at the app associated with the stethoscope.
Eko App
The app is free to download and in some countries, if available, a monthly subscription can be purchased to detect murmurs using artificial intelligence.
Setting up the app was straightforward. The good thing about the app is that the stethoscope is not solely connected to one device, meaning that if you’re using a different mobile device, you can still connect with your stethoscope. Once the stethoscope is paired to your phone via bluetooth, you can start listening to the sounds directly through the phone. This would be useful if you were listening to a patient’s chest and you wanted to share with them what you are hearing. They can listen live whilst you are listening too. A great feature, but one that when it is activated, it can make listening to the chest quite challenging. When I used this setting, I heard quite a lot of reverb and added noises that were maybe being transmitted through the stethoscope. You could potentially overcome this by placing the phone further away from the stethoscope (I had the phone within approximately 50–70cm from the stethoscope).
Another feature of the app which I found more useful was the ability to record the sounds straight from the stethoscope. I have in the past used the Littmann Bluetooth Stethoscope which has similar technology, however with this the sounds are stored directly on the stethoscope and then can be downloaded onto your desktop computer. This was very clunky to use and less straight forward, so I do appreciate Littmann’s advance in technology with regards to this. Out of the box, you can record up to 15 seconds of sounds, which I found to be sufficient, but you can modify this as wished.
You can also label the recordings and perhaps allocate them to patients — however I would be very mindful of putting patients’ personal data onto your mobile device. The app itself is reported to be HIPPA compliant but of course, mobiles can get lost.
When recordings are played back you can see the waveforms, which could be useful to see particularly if it was an abnormal heart sound. As I was not able to use the AI detection of murmurs, I cannot comment on its accuracy. However, one thing I will say is to be mindful of interpretations. This type of technology has been around for some time and the commonest place we see it is on ECG machines that usually provide a diagnosis for the patient. As medical students, we were always taught to interpret the ECG’s ourselves as most of the time the diagnosis would not be correct. So if you find yourself with an apparent murmur, I would exercise caution and ask a colleague if you are not sure on the diagnosis.
One of the negatives of the app was the lack of the share functionality. It appears that when the app was updated this feature was removed. I’m not sure why this would be. However it made saving my files to my mobile device very challenging. Instead, I would screen capture my recordings and save them this way. This was really quite cumbersome and could be easily streamlined with the return of the share function.
Conclusion
The Littmann Core Digital stethoscope has many useful features. I particularly liked the amplification to mid way, I also really enjoyed recording heart sounds and playing them back on my mobile device. Whilst I would routinely use the amplifier I’m not sure that I would use the app or recording function as much as a General Practitioner. This could be in part, due to being time poor in a consultation and more so due to the idea of taking out my mobile device during the consult. I often feel that this could be perceived as being a little disrespectful to the person in front of me. However, this feature could be immensely useful for medical students in training, cardiologists or those who are learning about heart sounds and murmurs.
Would I purchase the stethoscope? For now, although I did enjoy the amplified sound, I couldn’t at this time justify the purchase. Generally in my consultation room, when I am listening to a patient there is usually little to no background noise, making auscultating easier. If however I was working on a busy ward or a nursing home, I may change my mind. But for now, I’m quite happy with my lighter, pink Littmann Classic III.
Let me know what you think of the stethoscope and whether you would consider buying it.
I hope that you have found this article helpful.
Take care and stay healthy,
Dr Nora x
Please note that the contents of this article are not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or medical condition.
