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Inter-observer variability in chest radiograph reading for diagnosing acute lung injury in children
François Angoulvant1, Juan Llor, Corinne Alberti
1Service de Réanimation et Surveillance Continue Pédiatriques, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris et Université Paris Diderot-Paris VII, Paris, France.
Insights
Inter-observer variability in interpreting chest radiographs for pediatric acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is significant. This variability impacts the reliability of research on pediatric ALI/ARDS.
Area of Science:
- Pediatric critical care medicine
- Radiology
- Respiratory medicine
Background:
- Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are severe conditions affecting children, with high mortality rates.
- Standardized definitions are essential for reliable pediatric ALI/ARDS research, particularly regarding radiographic criteria.
Purpose of the Study:
- To assess the inter-observer variability in interpreting chest radiographs for the American-European Consensus Conference (AECC) radiographic criterion for ALI/ARDS in children.
- To evaluate the reliability of radiographic assessment for pediatric ALI/ARDS diagnosis.
Main Methods:
- A retrospective review of chest radiographs from 24 pediatric patients diagnosed with ALI/ARDS.
- Interpretation of frontal chest radiographs by five pediatric radiologists and five pediatric intensivists.
- Statistical analysis using raw agreement and Kappa coefficients to measure inter-observer variability.
Main Results:
- Fair global inter-observer agreement was found, with Kappa coefficients ranging from 0.26 to 0.29.
- Significant variability existed among both radiologists and intensivists in assessing the AECC radiographic criterion.
- Findings are consistent with previous studies in adult populations.
Conclusions:
- Considerable inter-observer variability exists in the interpretation of chest radiographs for pediatric ALI/ARDS.
- This variability poses a challenge for conducting homogeneous and reliable international multicenter studies on pediatric ALI/ARDS.
- A reproducible definition is crucial for advancing research and understanding of pediatric ALI/ARDS.
Abstract:
Acute lung injury (ALI), including its most serious form called acute respiratory distress syndrome (ARDS), is a devastating disease that can occur at any age. ALI/ARDS accounts for only 5-8% of admissions to pediatric intensive care units (PICUs) but is fatal in 30-60% of cases. International multicenter prospective studies are needed to better understand pediatric ALI/ARDS. However, a reproducible definition of ALI/ARDS is crucial to ensure that study populations are homogeneous. We designed a retrospective review to test the inter-observer variability of chest radiograph interpretation for presence of the American-European Consensus Conference (AECC) radiographic criterion for ALI/ARDS. The medical files of 24 children ventilated for ALI/ARDS in our PICU between January 1993 and December 2002 were reviewed. Five pediatric radiologists and five pediatric intensivists interpreted one frontal chest radiograph (FCR) per patient taken on the day of ALI/ARDS diagnosis. Each reader indicated whether the radiograph showed the AECC radiographic criterion for ALI/ARDS. Data analysis involved comparing each reader to all the others based on the raw agreement and Kappa coefficient (kappa). Features in the 24 patients were consistent with earlier studies. Global inter-observer agreement beyond chance was fair (kappa = 0.29 +/- 0.02) among the five radiologists (kappa = 0.26 +/- 0.05) and among the five intensivists (kappa = 0.29 +/- 0.05). Thus, considerable inter-observer variability occurred in assessing the radiographic criterion for ALI/ARDS, as previously shown in adults. Given the low incidence of ALI/ARDS in children, this variability may have a large impact in studies of pediatric ALI/ARDS.
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