Interobserver Variability in the Radiographic Diagnosis of Adult Outpatient Pneumonia

Melbye, Hasse; Dale, Knut

doi:10.1177/028418519203300117

Cited by 47 publications

(39 citation statements)

References 7 publications

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“…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.…”

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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“…Previous studies have shown great variation in the interpretation of the radiological diagnosis of various other diseases (9,13). CT has not been sufficiently evaluated as a method of diagnosing acute sinusitis, nor as to interobserver variation (5, 14,17).…”

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confidence: 99%