Variability in the interpretation of chest radiographs for the diagnosis of pneumonia in children

被引:88
|
作者
Neuman, Mark I. [1 ]
Lee, Edward Y. [2 ]
Bixby, Sarah [2 ]
Diperna, Stephanie [2 ]
Hellinger, Jeffrey [3 ]
Markowitz, Richard [3 ]
Servaes, Sabah [3 ]
Monuteaux, Michael C. [1 ,4 ]
Shah, Samir S. [5 ,6 ,7 ]
机构
[1] Childrens Hosp, Div Emergency Med, Boston, MA 02115 USA
[2] Childrens Hosp, Dept Radiol, Boston, MA 02115 USA
[3] Univ Penn, Sch Med, Dept Radiol, Philadelphia, PA 19104 USA
[4] Childrens Hosp, Clin Res Program, Boston, MA 02115 USA
[5] Univ Penn, Sch Med, Dept Pediat, Philadelphia, PA 19104 USA
[6] Univ Penn, Sch Med, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
[7] Childrens Hosp Philadelphia, Div Infect Dis, Philadelphia, PA 19104 USA
关键词
COMMUNITY-ACQUIRED PNEUMONIA; STANDARDIZED INTERPRETATION; PREVENTION; AGREEMENT;
D O I
10.1002/jhm.955
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Although chest radiography is commonly used to establish the diagnosis of pneumonia in children, the reliability of radiographic findings among radiologists is not well described. OBJECTIVE: We sought to evaluate the inter-rater and intra-rater reliability of radiographic features commonly described by radiologists in childhood pneumonia. METHODS: Prospective case-based study. One hundred and ten radiographs of children evaluated in a pediatric emergency department for suspicion of pneumonia were interpreted by six radiologists at two academic children's hospitals. Radiologists were blinded to the clinical history. Reliability of standardized radiographic features was evaluated using the kappa statistic. RESULTS: The radiographic finding of an alveolar infiltrate demonstrated substantial reliability among radiologists (kappa = 0.69). The presence of 'any infiltrate' and pleural effusion demonstrated moderate reliability (kappa = 0.47 and k = 0.45, respectively). Other radiographic features were less reliable: air bronchograms (kappa = 0.32), hilar adenopathy (kappa = 0.21), and interstitial infiltrate (kappa = 0.14). Similarly, the finding of alveolar infiltrate demonstrated substantial intra-rater reliability upon review of ten duplicate radiographs, whereas interstitial infiltrate was less reliable. CONCLUSION: The radiographic finding of an alveolar infiltrate is very reliable among pediatric radiologists, whereas the finding of an interstitial infiltrate is less reliable. Journal of Hospital Medicine 2012;7:294-298. (C) 2011 Society of Hospital Medicine.
引用
收藏
页码:294 / 298
页数:5
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