Agreement between emergency physician diagnosis and radiologist reports in patients discharged from an emergency department with community-acquired pneumonia

Campbell, Samuel; Murray, D; Hawass, Ammar; Urquhart, David G.; Ackroyd‐Stolarz, Stacy; Maxwell, David

doi:10.1007/s10140-005-0413-4

Cited by 38 publications

(18 citation statements)

References 30 publications

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“…Indeed, chest radiography (CXR), the standard imaging technique for pneumonia in the emergency department, has great limitations. One large study, among many others, showed the high interoperator variability reading of chest film [2]. This stands in contrast with the high accuracy and low variability showed in lung ultrasound studies [3].…”

Section: To the Editormentioning

confidence: 88%

Lung ultrasound and pulmonary consolidations

Volpicelli

Zanobetti

2015

The American Journal of Emergency Medicine

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Section: To the Editormentioning

confidence: 88%

Lung ultrasound and pulmonary consolidations

Volpicelli

Zanobetti

2015

The American Journal of Emergency Medicine

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“…5,6,15,16,19 When the above mentioned studies evaluated the interobserver agreement in order to define the presence of pneumonia in both children and adults, the results were poor to moderate (< 0.4 to 0.59), [3][4][5][6][11][12][13][14]24 while the percentage of agreement ranged between 41% and 87%. 18,[21][22][23]25 These values, however, depended on the specialty, expertise and level of training of readers, [3][4][5][6]11,14,16,18,19,21,24,25 and the radiological characteristics evaluated. In this regard, Albaum et al 7 and Boersma et al 8 encountered very similar findings, including the poor interobserver agreement for the type of infiltrates (≤ 0.3) and presence or absence of air bronchogram (≤ 0.31), poor to moderate agreement for pleural effusion (≤ 0.46), and moderate to good for multilobar pneumonia (≤ 0.67) and location of infiltrates (≤ 0.77).…”

Section: Discussionmentioning

confidence: 99%

Reading and interpretation of chest X-ray in adults with community-acquired pneumonia

Moncada¹,

Rueda²,

Macías³

et al. 2011

Braz J Infect Dis

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Introduction: Traditional reading of chest X-rays usually has a low prognostic value and poor agreement. Objective: This study aimed to determine the interobserver and intraobserver agreement using two reading formats in patients with community-acquired pneumonia, and to explore their association with etiology and clinical outcomes. Methods: A pulmonologist and a radiologist, who were blind to clinical data, interpreted 211 radiographs using a traditional analysis format (type and location of pulmonary infiltrates and pleural findings), and a quantitative analysis (pulmonary damage categorized from 0 to 10). For both, the interobserver and intraobserver agreement was estimated (Kappa statistic and intraclass correlation coefficient). The latter was assessed in a subsample of 25 radiographs three months after the initial reading. Finally, the observers made a joint reading to explore its prognostic usefulness via multivariate analysis. Results: Seventy-four chest radiographs were discarded due to poor quality. With the traditional reading, the mean interobserver agreement was moderate (0.43). It was considered good when the presence of pleural effusion, and the location of the infiltrates in the right upper lobe and both lower lobes, were evaluated; moderate for multilobar pneumonia; and poor for the type of infiltrates. The mean intraobserver agreement for each reviewer was 0.71 and 0.5 respectively. The quantitative reading had an agreement between good and excellent (interobserver 0.72, intraobserver 0.85 and 0.61). Radiological findings were neither associated to a specific pathogen nor to mortality. Conclusion: In patients with pneumonia, the interpretation of the chest X-ray, especially the smallest of details, depends solely on the reader.

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“…Similar results were reported by another study of 353 elderly patients which found that functional impairment at admission correlated strongly with death. 19,20 Factors that contribute to mortality in the elderly correlate to functional and cognitive impairment, functional decline, disease severity, comorbidity scores, older age and male gender. 21 In our study related comorbidities were not associated with 30-day mortality.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with 30-day mortality in elderly inpatients with community acquired pneumonia during 2 influenza seasons

Torner

Izquierdo

Soldevila

et al. 2016

Human Vaccines & Immunotherapeutics

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Community-acquired pneumonia (CAP) refers to pneumonia unrelated to hospitals or extended-care facilities. The aim of this study was to determine factors associated with 30-day mortality in patients with CAP aged 65 y admitted to 20 hospitals in 7 Spanish regions during the 2013-14 and 2014-15 influenza seasons. Logistic regression was used to identify factors associated with 30-day mortality. The adjusted model included variables selected by backward elimination with a cut off of < 0.02. A total of 1928 CAP cases were recorded; 60.7% were male, 46.67% were aged 75-84 years, and 30-day mortality was 7.6% (n D 146). Pneumococcal vaccination had a significant protective effect (OR 0.68, 95% CI, 0.48-0.96; p D 0.03) and influenza vaccination in any 3 preceding seasons slight protective effect against CAP (OR 0.72, 95% CI, 0.51-1.02;p D 0.06). Factors significantly associated with 30-day mortality were having a degree of dependence (aOR 3.67, 95% CI, 2.34-5.75; p < 0,001); age 85 y (OR 3.01, 95% CI, 1.71-5.30; p < 0.001), liver impairment (aOR 2.41, 95% CI, 1.10-5.31; p D 0.03); solid organ neoplasm (aOR 2.24, 95% CI, 1.46-3.45; p < 0.001), impaired cognitive function (aOR 1.93, 95% CI, 1.22-3.05; p D 0.005), and ICU admittance (aOR2.56, 95% CI, 1.27-5.16; p D 0.009); length of stay (aOR 1.56, 95% CI, 1.02 -2.40; p D 0.04) and cardio-respiratory resuscitation (aOR 7.75, 95% CI, 1.20 -49.98; p D 0.03). No association was observed for other comorbidities such as chronic pulmonary obstructive disease (COPD) or heart conditions in the adjusted model. Offering both pneumococcal and influenza vaccination to the elderly may improve 30-day mortality in patients with CAP.

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Agreement between emergency physician diagnosis and radiologist reports in patients discharged from an emergency department with community-acquired pneumonia

Cited by 38 publications

References 30 publications

Lung ultrasound and pulmonary consolidations

Lung ultrasound and pulmonary consolidations

Reading and interpretation of chest X-ray in adults with community-acquired pneumonia

Factors associated with 30-day mortality in elderly inpatients with community acquired pneumonia during 2 influenza seasons

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