Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study

Abstract

Background.Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials.Methods.The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1–59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion.Results.A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (κ = 0.50) and between arbitrators was 84% (κ = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (κ = 0.25) and 48.5% (κ = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively).Conclusions.Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process.

Colonization Density of the Upper Respiratory Tract as a Predictor of Pneumonia—Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii

“…Severe pneumonia was defined as having cough or difficulty breathing and lower chest wall indrawing; very severe pneumonia was defined as cough or difficulty breathing and at least 1 of the following: central cyanosis, difficulty breastfeeding/drinking, vomiting everything, convulsions, lethargy, unconsciousness, or head nodding [25]. Within this case definition we further defined radiographic pneumonia as consolidation or any other infiltrate on chest radiograph (CXR positive) as interpreted by a panel of trained CXR readers [26, 27]. Microbiologically confirmed cases were those with identification of the respective pathogen by PCR from lung aspirate or pleural fluid; bacterial culture from lung aspirate, pleural fluid, or blood; or P. jirovecii by induced sputum, pleural fluid, or lung aspirate immunofluorescence or toluidine blue staining [28].…”

Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

“…Chest radiographs were assessed by a radiologist during routine clinical care. These radiological findings and the corresponding images were retrospectively reviewed by 2 of the authors, who were blinded to clinical information, using criteria for radiographic pneumonia [18,19].…”

Density of Upper Respiratory Colonization With Streptococcus pneumoniae and Its Role in the Diagnosis of Pneumococcal Pneumonia Among Children Aged <5 Years in the PERCH Study

“…CXRs were obtained at admission for cases, and each digital image was assessed by 2 members of a panel of 14 radiologists and pediatricians trained in the standardized interpretation of pediatric CXRs; films with discordant conclusions were adjudicated [21,22]. Clinical characteristics, including oxygen saturation, were assessed on the day of enrollment.…”