Interobserver agreement in the radiological diagnosis of lower respiratory tract infections in children

Abstract

Objective: To evaluate the inter-observer agreement of radiological diagnosis of lower respiratory tract infections in children. Methods: Chest X-rays from 60 children younger than 5 years of age were evaluated by three physicians: a pediatric radiologist (PR), a pediatric pulmonologist (PP) and an experienced emergency pediatrician (EP). All children had sought an emergency room due to acute respiratory infections with apparent lower respiratory tract involvement. Observers were blinded to the original diagnostic conclusions, but clinical and laboratory data from the initial medical evaluation were provided with each film. Variables were grouped into five categories: a) film quality; b) site of abnormality; c) radiological patterns; d) other radiographic images; e) diagnosis. Inter-observer agreement was assessed using Kappa statistics, accepting prevalence-bias-adjusted values (PABAK). Results: Kappa values for each of the three observer pairs (RP vs. PP, RP vs. EP, and PP vs. PE) were 0.41, 0.43, and 0.39, respectively. The overall inter-observer agreement was moderate (0.41). Agreement on other variables was as follows: regular for "film quality" (0.30); moderate for "site of abnormality" (0.48); fair for "radiological patterns" (0.29); moderate for "other radiographic images" (0,43); and moderate for "diagnosis" (0.33). The overall intra-observer agreement was "moderate" (0.54), which is below the agreement values reported by other studies on chest Xray variability. Conclusions: Inter-observer variability is an intrinsic characteristic of the interpretation of chest X-rays, and the diagnosis of lower respiratory tract infections in children remains a challenge. Most of our results were similar to those previously reported.

Prevalência e gravidade da sibilância no primeiro ano de vida

“…It is likely that the number of infants diagnosed with pneumonia was overestimated in our sample, because the limitations, difficulties, and contradictions in the diagnosis of acute infectious pulmonary diseases in children are extremely common in clinical practice. (18) However, the high percentage of infants who had respiratory infection with pulmonary impairment in this sample is still a cause of concern. According to the Brazilian National Ministry of Health, respiratory diseases were responsible for 34.5% of all hospital admissions of children less than one year of age nationwide in 2006.…”

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

“…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). Also, Sarria et al 11 and Venera et al 3 found poor to moderate agreement for the variables mentioned in pediatric populations.…”

“…Most of them have assessed the agreement, or the percentage of agreement, between radiologists, pulmonologists, pediatricians, internists, emergency department specialists, residents and medicine students, in both children 3,4,11,[13][14][15][16][17] and adults, [5][6][7][8]12,[18][19][20][21][22][23][24][25] and the association with the etiologic agent, 8,[15][16][17] clinical presentation and outcomes. 20,23 Several of these studies have also estimated sensitivity, specificity and predictive values of chest X-rays for the diagnostic of pneumonia, its etiology and mortality.…”

“…20,23 Several of these studies have also estimated sensitivity, specificity and predictive values of chest X-rays for the diagnostic of pneumonia, its etiology and mortality. 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.…”

“…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).…”