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

Abstract

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 (κ = 0.69). The presence of ‘any infiltrate’ and pleural effusion demonstrated moderate reliability (κ = 0.47 and k=0.45, respectively). Other radiographic features were less reliable: air bronchograms (κ = 0.32), hilar adenopathy (κ = 0.21), and interstitial infiltrate (κ = 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; © 2011 Society of Hospital Medicine.

Advances in the diagnosis of pneumonia in children

“…Ultrasound has several advantages over other imaging modalities: it can be performed at POC, it is feasible and less costly than chest radiography, it is less affected by movement or crying than other imaging modalities, it can be done in sleeping children, 35 and it is free of ionizing radiation. [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Although ultrasound performed by non-radiologists is controversial, it has become a useful tool for physicians, emergency medicine doctors, and intensivists. 44 Lung ultrasound involves scanning a child in the anterior, lateral, and posterior areas of each hemithorax.…”

Accuracy of the Interpretation of Chest Radiographs for the Diagnosis of Paediatric Pneumonia

“…In epidemiological studies, the chest radiograph remains a major criterion in classifying pneumonia [3], [4]. However, variability in its interpretation for the diagnosis of pneumonia in children is a recognised problem [5]. It has been suggested that if radiologists follow the standardised World Health Organization (WHO) radiological definitions of pneumonia [3], this would allow more accurate comparative data in epidemiological studies for assessment of the impact of pneumococcal vaccination [4].…”

Lung Ultrasonography: A Viable Alternative to Chest Radiography in Children with Suspected Pneumonia?

“…It exposes patients to ionizing radiation, and ill children with suspected pneumonia may receive multiple CXRs, posing a small increased risk of cancer later in life. [2][3][4] Lung ultrasonography (LUS) has several potential advantages over CXR. Compared with CXR, LUS does not expose the child to ionizing radiation, when used to address specific diagnostic questions requires minimal training for the provider, and can be performed at the point of care.…”