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Updated: Aug 18, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Inter- and intra-observer variability in the assessment of atelectasis and consolidation in neonatal chest
F H Bloomfield1, R L Teele, M Voss
1Department of Paediatrics, National Women's Hospital, Claude Road, Epsom, Auckland, New Zealand.
Insights
Radiologist agreement on neonatal chest X-rays for lung conditions like atelectasis is inconsistent. This variability impacts respiratory management and research in neonatal intensive care.
Area of Science:
- Neonatal radiology
- Pediatric critical care
- Diagnostic imaging interpretation
Background:
- Radiology is crucial for neonatal intensive care, guiding respiratory management.
- Consistency in interpreting neonatal chest radiographs remains under-assessed.
Purpose of the Study:
- To evaluate inter- and intra-observer variability in reporting neonatal chest radiograph findings.
- Specifically assessing agreement on atelectasis and consolidation diagnoses.
Main Methods:
- Two radiologists analyzed 585 neonatal chest radiographs for various forms of atelectasis/consolidation.
- One radiologist re-evaluated a subset (n=117) after two months.
- Agreement assessed using kappa statistics and proportion of agreement.
Main Results:
- Inter-observer agreement for focal atelectasis was fair to moderate (kappa=0.25-0.44).
- Intra-observer agreement was generally moderate to good (kappa=0.38-0.66).
- Focal abnormalities were present in 21-26% of films.
Conclusions:
- Poor inter-observer agreement highlights challenges in diagnosing neonatal pulmonary abnormalities from radiographs.
- Consider describing radiographic findings rather than providing definitive diagnoses.
- Acknowledge reporting inconsistencies in neonatal radiographic research.
Background:
Radiology is an essential part of neonatal intensive care. Interpretation of chest radiographs frequently contributes to respiratory management of neonates, but there has been little assessment of the consistency of this interpretation.
Objective:
To assess the inter- and intra-observer variability for the reporting of atelectasis and/or consolidation in neonatal chest radiographs.
Materials And Methods:
A total of 585 chest radiographs from the 220 babies ventilated in our nursery over a 2-year period were coded by two radiologists for generalised, lobar and segmental atelectasis and/or consolidation. Two months later one of the radiologists re-coded a random sample of these films (n = 117, 20 %). Agreement was assessed by the kappa statistic and by proportions of agreement for normality and abnormality.
Results:
The reported incidence of focal atelectasis was low (5-6 %). Focal changes of any nature were found in 21-26 % of films. Inter-observer agreement was fair to moderate (kappa = 0.25-0.44). Intra-observer agreement was mostly moderate to good (kappa = 0.38-0.66).
Conclusion:
The poor inter-observer agreement for the diagnosis of pulmonary parenchymal abnormalities on chest radiographs of neonates receiving intensive care suggests that abnormalities should be described rather than diagnoses given or that a list of differential diagnoses be offered. When research involves radiographic interpretation, the potential lack of consistency in reporting abnormalities must be borne in mind.
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