Interobserver Variability in the Interpretation of Chest Roentgenograms of Patients With Possible Pneumonia

Young, Michelle; Marrie, Thomas J.

doi:10.1001/archinte.1994.00420230122014

Cited by 107 publications

(62 citation statements)

References 14 publications

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“…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.…”

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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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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“…Single clinical signs as well as diagnostic rules consisting of a set of criteria do not provide satisfactory performances in predicting the presence of pneumonia [8±11]. Chest radiographs are also only of limited value in the imaging of mild infiltrates [12,13]. Moreover, since only every 10th or 20th patient with LRTI is expected to have true pneumonia [14], thus resulting in a low prevalence, the positive predictive value of any diagnostic rule will be low.…”

Section: Detecting Mild Pneumoniamentioning

confidence: 99%

Severity assessment in community-acquired pneumonia

Ewig¹,

Schäfer²,

Torres³

2000

Eur Respir J

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In current guidelines for the management of adults with community‐acquired pneumonia (CAP), the triaging decision about hospitalization or intensive care unit (ICU) admission, and, as a consequence, selection of initial antimicrobial treatment is largely based on the assessment of pneumonia severity. The proposed severity criteria are mainly derived from studies determining pre‐dictors of adverse outcome. These include age, male sex, comorbidity, acute respira‐tory failure, severe sepsis and septic shock, extension of radiographic infiltrates, bacteraemia and CAP through several different pathogens such as Streptococcus pneumoniae, Staphylococcus aureus, Gram‐negative enteric bacilli (GNEB), and signs of disease progression within the first 48–72 h. In addition, prediction rules and need for a complicated course in ambulatory and hospitalized patients, for the individual risk of death have been developed which may be helpful in determining the patient who might require hospitalization or intensive care, respectively. Risk classifications such as the scores developed by F ineet al. [40] are not only useful for identifying low risk patients who might safely be treated as outpatients, but apparently they will also play a major role in the evaluation of processes and outcomes of care for patients with CAP. Recent investigations have provided objective criteria for the definition of severe CAP requiring ICU admission. Whether the detection of infiltrates in the chest radiographs of patients with acute lower respiratory tract infection (LRTI) suggestive of mild pneumonia has an independent prognostic impact which fundamentally affects the concept of mild LRTI remains to be seen. Based on objective criteria for severity assessment it will be possible to define interventions aimed at reducing hospital admission rates, define a risk‐adapted anti‐microbial treatment regimen, reduce costs for antimicrobial treatment and supportive measures, shorten hospital stay, and, thereby, improve the quality of care for patients with community‐acquired pneumonia.

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“…Moreover, initial chest radiography is not totally sensitive, and there can be significant inter-observer variability in the reading and interpretation of the radiograph. 15 In transplant patients, a careful history and meticulous physical examination remain very imperative. However it should be noted that diagnostic utility of the physical examination is limited.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Physician Judgment for Diagnosis of Pneumonia in Transplant Patients with Fever in Emergency Settings

Bektaş¹,

Söyüncü²,

Yiğit³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of the study is to determine the diagnostic accuracy of emergency physician judgment for diagnosis of pneumonia in transplant patients with fever in emergency settings. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This prospective, convenience sample study was performed in a tertiary care university emergency department. All solid organ transplant patients presenting to the emergency department with fever as a chief complaint, between 08:00 and 24:00 hours were enrolled into the study. Before performing chest X-ray, according to the clinical findings of pneumonia, emergency physician need to assign a pre-chest X-ray level of certainty for pneumonia using a visual analog scale from 0 mm to 100 mm, with 100 mm being the most certain. The chest X-ray reports were classified into three groups: Normal, pneumonia (having pulmonary infiltrates diagnostic and suggestive of pneumonia) and abnormal but not pneumonia. R Re es su ul lt ts s: : Of the 77 study patients, 10 (13%) patients were diagnosed as pneumonia. Sensitivity, specificity and positive and negative likelihood ratio of the judgment of emergency physician in diagnosing pneumonia in our patients population were 70% [95% confidence interval (CI): 35-91], 94% (95% CI: 84-98), 11.7 (95% CI: 4.1-32.9) and 0.31 (95% CI: 0.12-0.82), respectively. C Co on nc cl lu us si io on n: : In the presence of clinical signs of pneumonia, diagnostic accuracy of emergency physician judgment was high for diagnosis of pneumonia in transplant patients with fever in emergency settings. K Ke ey y W Wo or rd ds s: : Transplantation; pneumonia; emergency medicine; decision making Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmanın amacı, acil serviste, yüksek ateşli transplant hastalarında pnömoni tanısının konulmasında acil tıp uzman doktorunun klinik kararının doğruluğunu araştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Bu çalışma bir üniversite hastanesi acil servisinde ileriye dönük, uygun hastalar çalışmaya alınarak gerçekleştirilmiştir. Acil uzman doktorunun acil serviste çalıştığı 08:00-24:00 saatleri arasında, acil servise ana şikayet olarak ateş nedeniyle başvuran tüm solid organ transplantasyonu yapılmış hastalar çalışmaya alınmıştır. Acil Tıp Uzman Doktoru hastanın akciğer grafisi çekilmeden ve değerlendirmeden önce, hastanın pnömoniye ait klinik bulgularına göre, 0-100 mm'lik görsel analog skala kullanarak, 100 mm en kesin değer olacak şekilde, hastanın pnömoni olma olasılığını işaretledi. Çalışma sonucunda akciğer grafisi sonuçları üç grup altında sınıflandırılmıştır: Normal akciğer grafisi, pnömoni (pnömoniyi destekleyecek tanısal pulmoner infiltrasyonlar), anormal fakat pulmoner enfeksiyon değil. B Bu ul lg gu ul la ar r: : Çalışmaya alınan 77 hastanın içinde 10 hastaya pnömoni tanısı konulmuştur. Çalışmaya alınan hasta popülasyonunda, pnömoni tanısının konulmasında acil uzman doktorunun klinik kararının duyarlılığı, seçiciliği, pozitif ve negatif olma olasılığı sırasıyla %70 [%95 g...

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Interobserver Variability in the Interpretation of Chest Roentgenograms of Patients With Possible Pneumonia

Cited by 107 publications

References 14 publications

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

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

Severity assessment in community-acquired pneumonia

Accuracy of Physician Judgment for Diagnosis of Pneumonia in Transplant Patients with Fever in Emergency Settings

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