This update to the modern classic adds the ability to record, transmit, and simultaneously listen to the full range of frequencies. Is it an unnecessary upgrade, or a telemedicine game-changer?
When I was first asked to write a medical tech column for EPM I was ecstatic – I couldn’t wait to get my hands on the latest gadgets. Excitedly, I opened the box to my first evaluation product. To my disappointment, it was a vaginal speculum. “Is this what every month is going to be like?” I thought to myself. To my relief, the next month brought the Littmann 3000 to my door, which I reviewed almost three years ago to the day. While that review was mixed (though mostly positive), Littmann now has a chance to raise the bar. This month we are looking at Littmann’s latest electronic stethoscope, the 3200 model. We’ll see what three years of tech development have done for us.
Out of the box, the 3200 model very closely resembles the 3000, appearing much like a standard single-head stethoscope (i.e. Littmann’s Master Cardiology). Like the earlier model, the first thing you’ll notice is that the 3200 does not have the same heft of a high-quality analog stethoscope. However, the 3200 has added a bit more weight to the head, assuaging any previous concerns of flimsiness.
Taking a closer look at the head of the 3200, the first thing you’ll notice is the pleasing blue LCD screen. On screen are indicators for volume, diaphragm type, Bluetooth connection, battery level and heart rate. Below the LCD are buttons for these functions. The head itself is a single rubber piece that fits over the internal speaker of the stethoscope. I have had some problems with the thin protective layer peeling off of the head, but Littmann is aware of this issue and will replace the piece at no cost.
Unlike analog stethoscopes, Littmann’s electronic line does not have a traditional bell/diaphragm system where you press harder to activate the diaphragm and lighter for a bell.
Instead, with the 3200, you maintain good contact with the patient’s skin regardless of what sounds you are listening for. Variable diaphragms are chosen by selecting the desired setting with the diaphragm button. The first setting emphasizes lower frequencies (between 20-200 Hz), mimicking the bell. The next setting simulates the diaphragm, emphasizing frequencies between 100-500 Hz. The last setting, and the one found only on the 3200, is the extended range filter. Unlike analog stethoscopes, this allows for listening to the full spectrum of sounds simultaneously. This is possible because the Littmann electronic line picks up the full range of frequencies and the various settings are simply filters excluding the sounds outside of a set frequency.
The 3200 comes with a few different sized earpieces. The standard pieces fit me quite well, are comfortable to my ears and provide a perfect seal. One of the great benefits of electronic stethoscopes is the ability to adjust the volume. Between the excellent seal and the adjustable volume, the 3200 easily drowns out the din of my hectic ED. The sounds remained clear and undistorted even when the volume was turned to its maximum setting.
Improvements on the diaphragm and filtering systems of the 3200 minimize outside noise interference when compared to the 3000. Nevertheless, the 3200 works significantly better when used directly on the patient’s skin, as opposed to through clothing. You must also take care not to brush against clothing. When good contact is made, you get excellent acoustics.
An added bonus new to the Littmann electronic line is the ability to display heart rate. Place the 3200 on your patient’s chest for 15-20 seconds and the LCD will show their HR. While not a show-stopper, its yet another reason why I no longer need a watch.
The 3200 allows for recording of all sounds transmitted through the stethoscope. Recorded heart sounds can then be analyzed via two different software products from Zargis. The first is StethAssist, which allows for transmission of sounds via wireless Bluetooth to a PC and comes free with the 3200. You can then play back recorded sounds, which are displayed as sound waves. By recording the full spectrum of frequencies, regardless of which filter you are using, the software allows you to add or remove filters when playing back. This is very useful if you inadvertently had the high frequency filter on when you recorded that great cardiac murmur. Simply change the filter on the software and you have the great cardiac exam you meant to record.
The second Zargis product is Cardioscan, which is an advanced “Heart Sound Detection Software” product that costs $440. Like StethAssist, Cardioscan allows you to transmit and listen to recorded heart sounds on a PC. But Cardioscan takes things a step further by assessing the recorded heart sounds for S1/2 sounds as well as both systolic and diastolic murmurs.
I had the chance to use both software products and they install quite easily. As a Mac user, I was a bit bummed that it is Windows-only, so I had to seek out a PC to test it. Transmission of sounds is very quick and easy and the software is intuitive to use. As an instructor at an EM residency, I can see the utility for education and lectures if you find a great murmur. But let’s be honest, are there any sounds you’re going to find and record that you can’t already find via Google? Its ability to properly identify murmurs certainly outperforms my own, but I’d argue, “That’s why we have ultrasound machines.” In the end, I’m not sure that the software serves any real purpose in most emergency departments since there are usually better tests at our disposal. As a military physician, I could see some utility in remote use. Maybe not for the troops, but perhaps for humanitarian missions where field triage of an abnormal heart sound might prompt you to send a patient to a center that can perform an echo. While I won’t be using Cardioscan in my daily practice, it is nonetheless an impressive piece of software engineering that seems almost magical.
Finally, I want to spend a minute discussing an interesting product from Zargis that I didn’t get to use: TeleSteth. This is another innovative piece of software that allows a remote physician using a 3200 to transmit their patient’s heart sounds via the internet to another physician anywhere in the world. This can be done asynchronously with recorded heart sounds or in real-time while the on-site physician is actively listening to the patient’s chest. Sounds sent through TeleSteth can also be analyzed via Cardioscan during the transmission. Again, I see great potential for field-work, allowing for expert assessment without the expert being in the field.
In the end, the 3200 is a nice step up from the last two generations of Littmann electronic stethoscopes. It has superior sound and filtering, and the addition of Bluetooth and supporting software really takes this product into the 21st century. If you are looking to save around a hundred bucks, you can get 3200 quality in the 3100 model. You’ll only sacrifice the ability to record, transmit, and simultaneously listen to the full range of frequencies. While the 3200 is a nice total package, I think the 3100 would serve most EP’s needs in all settings outside of very specific field-work. If you have a prior generation electronic stethoscope that you aren’t really happy with, now may be the time to upgrade and give your old scope to a medical student in need. But let’s face it, they probably won’t want that outdated tech anyway. It’s gonna be hard to go back to my 3000.
The Lowest Bidder: The Littmann 3200 lists at $549.99, but you can find it for significantly cheaper, around $375 online. The 3100 model lists for $399, but can be found for as low as $312.
Rating: 4.5 Stars
Photo credit: Special thanks to Drew Wagner for his assistance.
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