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

Introduction World Health Organization (WHO) radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia. Methods An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification. Results There was significant disagreement (22%) between the first and second reports (kappa = 0.70, P<0.001), notably in those aged <5 years (26%, kappa = 0.66, P<0.001). The most frequent sources of disagreement were the reporting of patchy and perihilar changes. Conclusion This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children.

[1]  R G Swensson,et al.  Radiographic interpretation with and without search: visual search aids the recognition of chest pathology. , 1982, Investigative radiology.

[2]  N Taub,et al.  An assessment of inter-observer agreement and accuracy when reporting plain radiographs. , 1997, Clinical radiology.

[3]  M. Koenig,et al.  Discordant radiograph interpretation between emergency physicians and radiologists in a pediatric emergency department. , 1999, Pediatric emergency care.

[4]  J. Kline,et al.  Intraobserver and interobserver agreement of the interpretation of pediatric chest radiographs , 2010, Emergency Radiology.

[5]  J. Carlin,et al.  Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. , 2005, Bulletin of the World Health Organization.

[6]  M. Cardoso,et al.  The inter‐observer variation of chest radiograph reading in acute lower respiratory tract infection among children , 2013, Pediatric pulmonology.

[7]  A. Yinnon,et al.  Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia. , 2010, The American journal of medicine.

[8]  N. Müller,et al.  Fleischner Society: glossary of terms for thoracic imaging. , 2008, Radiology.

[9]  A. Gennery,et al.  Aetiology of paediatric pneumonia after the introduction of pneumococcal conjugate vaccine , 2013, European Respiratory Journal.

[10]  Ian Riley,et al.  Clinical case review: A method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia , 2008, BMC infectious diseases.

[11]  H. S. Patterson,et al.  Is infiltrate a useful term in the interpretation of chest radiographs? Physician survey results. , 2005, Radiology.

[12]  G. Stickler,et al.  Problems in the Clinical and Roentgenographic Diagnosis of Pneumonia in Young Children , 1984, Clinical pediatrics.

[13]  M. Driel,et al.  Chest radiograph for acute respiratory infections , 2011 .

[14]  S. Madhi,et al.  World Health Organisation definition of "radiologically-confirmed pneumonia" may under-estimate the true public health value of conjugate pneumococcal vaccines. , 2007, Vaccine.

[15]  L. Garland.  Studies on the accuracy of diagnostic procedures. , 1959, The American journal of roentgenology, radium therapy, and nuclear medicine.

[16]  Garland Lh.  Studies on the accuracy of diagnostic procedures. , 1959 .

[17]  John S. Bradley,et al.  The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  Samir S. Shah,et al.  Variability in the interpretation of chest radiographs for the diagnosis of pneumonia in children. , 2012, Journal of hospital medicine.

[19]  D. Greenberg,et al.  Evaluation of the World Health Organization criteria for chest radiographs for pneumonia diagnosis in children , 2012, European Journal of Pediatrics.

[20]  A. Harnden,et al.  British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011 , 2011, Thorax.

[21]  Les Irwig,et al.  Accuracy of diagnostic tests read with and without clinical information: a systematic review. , 2004, JAMA.

[22]  K. Berbaum,et al.  Error in radiology: classification and lessons in 182 cases presented at a problem case conference. , 1992, Radiology.

[23]  T. Hazir,et al.  Chest radiography in children aged 2-59 months diagnosed with non-severe pneumonia as defined by World Health Organization: descriptive multicentre study in Pakistan , 2006, BMJ : British Medical Journal.

[24]  K. O'Brien.  Standardization of interpretation of chest radiographs for the diagnosis of pneumonia in children , 2001 .

[25]  Leonard Berlin,et al.  Accuracy of diagnostic procedures: has it improved over the past five decades? , 2007, AJR. American journal of roentgenology.