Interobserver Reliability of the Chest Radiograph in Community-Acquired Pneumonia

Albaum, Michael N.; Hill, Lisa; Murphy, Miles; Li, Yi-Hwei; Fuhrman, Carl R.; Britton, Cynthia A.; Kapoor, Wishwa N.; Fine, Michael J.

doi:10.1378/chest.110.2.343

Cited by 236 publications

(152 citation statements)

References 27 publications

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“…We attempted to increase uniformity in assessment by using a protocol for reporting. Interobserver variability remained, but the moderate unweighted kappa of 0.45 was similar to other studies [6,8]. Moreover, re-analysis with radiographic pneumonia as a reference test, as diagnosed by a second single assessor, showed comparable results (sensitivity, specificity, PPV and NPV of 20%, 98%, 42% and 94%, respectively).…”

Section: Strengths and Limitationssupporting

confidence: 85%

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Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography

et al. 2013

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Pneumonia is often diagnosed and treated empirically. We set out to determine the diagnostic accuracy of clinical judgment based on signs and symptoms to detect radiographic pneumonia in patients presenting with acute cough in primary care.In 2810 European patients with acute cough, general practitioners (GPs) recorded whether they considered pneumonia to be present (“yes” or “no”) immediately after history and physical examination. Chest radiography was performed within 1 week by local radiologists blind to other patient characteristics.140 patients had radiographic pneumonia (5%), of whom 41 (29%) had been diagnosed as such. 31 (1%) patients had a clinical diagnosis that was not confirmed by radiography (n=2670). In clinically suspected pneumonia, 57% of subjects were subsequently diagnosed with radiographic pneumonia. Negative predictive value (NPV), sensitivity and specificity of GPs’ clinical judgment were 96%, 29% and 99%, respectively. Compared to patients with a clinical diagnosis of pneumonia, less severe symptoms were found in radiographic pneumonia cases not suspected clinically (p<0.05).The predictive values of GPs’ clinical judgment, particularly the high NPVs, are helpful in routine care. Nonetheless, the majority of diagnoses of radiographic pneumonias was not suspected on clinical grounds. There is a need to further support the detection of clinically relevant pneumonia in primary care.

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Section: Strengths and Limitationssupporting

confidence: 85%

“…de Jong) at the University Medical Center Utrecht (Utrecht, the Netherlands) and interobserver variability was determined [6][7][8].…”

Section: Methodsmentioning

confidence: 99%

Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography

et al. 2013

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“…2,[4][5][6] Prior investigations have noted poor overall agreement by emergency medicine, infectious diseases, and pulmonary medicine physicians, and even radiologists, in their interpretation of chest radiographs for the diagnosis of pneumonia. 2,5,[7][8][9][10] The World Health Organization (WHO) developed criteria to standardize CXR interpretation for the diagnosis of pneumonia in children for use in epidemiologic studies. 11 These standardized definitions of pneumonia have been formally evaluated by the WHO 6 and utilized in epidemiologic studies of vaccine efficacy, 12 but the overall reliability of these radiographic criteria have not been studied outside of these forums.…”

Section: Discussionmentioning

confidence: 99%

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

Neuman

Lee

Bixby

et al. 2011

Journal of Hospital Medicine

125

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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.

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“…Some interobserver variability remained, but the moderate agreement for pneumonia (κ = 0.47) was comparable to other studies. [19][20][21] Interobserver variability on incidental fi ndings (κ = 0.20) was much lower. The reporting protocol was less strictly defi ned for other fi ndings compared with the protocol for pneumonia and acute bronchitis, suggesting that other mechanisms, including subjectivity between radiologists possibly related to training and experience, may have played a role.…”

Section: Strengths and Limitationsmentioning

confidence: 94%

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

Vugt

Broekhuizen

Zuithoff

et al. 2012

The Annals of Family Medicine

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PURPOSE Imaging may produce unexpected or incidental fi ndings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental fi ndings are lacking. We set out to describe the type and prevalence of incidental chest radiography fi ndings in primary care patients with acute cough. METHODSWe report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specifi ed signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional fi nding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these fi ndings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. RESULTSIncidental fi ndings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental fi ndings. Suspected nodules and shadows were reported in 1.8%. Incidental fi ndings were more common is older participants and smokers (P <.001).CONCLUSIONS Clinically relevant incidental fi ndings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting. Ann Fam Med 2012;10:510-515. doi:10.1370/afm.1384. INTRODUCTIONA cute cough is one of the most common reasons for consulting in primary care. 1,2 Prompt, accurate diagnosis of pneumonia in these patients is important to rule in the need for timely appropriate antibiotic treatment in some patients and to rule out the need for antibiotic treatment in others. Responsible general practitioners order chest radiographs in a minority of patients with acute cough. 3 These radiographs confi rm pneumonia in 5% to 19% and exclude pneumonia in most patients. 2,4,5 Imaging provides information relevant to the acute illness but may also reveal incidental fi ndings. 6-9 Such fi ndings can benefi t patients through earlier diagnosis and treatment, for example, in as yet undiagnosed heart failure or malignancy. Incidental fi ndings, however, may have unknown or doubtful clinical relevance and lead to patient anxiety, expensive workup, and potentially harmful investigations and treatment without improving quality and length of life. 10,11 The nature and prevalence of incidental fi ndings on chest radiographs of patients who consult their general practitioner for acute cough is unknown. Such data may inform decisions about clinical indications for ordering chest radiographs. We studied incidental fi ndings on chest radiographs obtained METHODSWe undertook a cross-sectional observational study using data from the GRACE-09/10a study (Genomics to comba...

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Interobserver Reliability of the Chest Radiograph in Community-Acquired Pneumonia

Cited by 236 publications

References 27 publications

Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography

Diagnosing pneumonia in patients with acute cough: clinical judgment compared to chest radiography

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

Incidental Chest Radiographic Findings in Adult Patients With Acute Cough

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