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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
[Evaluation of two standardized methods for chest radiographs interpretation in children with pneumonia]
Fernando Ferrero1, Fernando Torres, Eugenia Noguerol
1División Neumonología, Hospital de Niños Dr. Pedro de Elizalde, Buenos Aires, Argentina. fferrero@intramed.net
Insights
The World Health Organization (WHO) method and Khamapirad score accurately identify bacterial pneumonia in young children. The WHO method is simpler and offers better interobserver agreement for diagnosing childhood pneumonia.
Area of Science:
- Pediatric Radiology
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Accurate identification of bacterial pneumonia in young children is crucial for effective treatment.
- Chest radiography is a common diagnostic tool, but interpretation methods vary.
- Evaluating different scoring systems for chest radiograph interpretation is essential for improving diagnostic accuracy.
Purpose of the Study:
- To assess the accuracy of the World Health Organization (WHO) method for interpreting chest radiographs in identifying bacterial pneumonia in children under five.
- To compare the diagnostic accuracy of the WHO method against the Khamapirad scoring system.
- To evaluate interobserver agreement for both scoring systems.
Main Methods:
- Chest radiographs of 108 children under 5 with pneumonia (microbiologically confirmed viral or bacterial) were reviewed by three blinded observers.
- Observers used the World Health Organization (WHO) scoring system and the Khamapirad score, with specific thresholds set for bacterial pneumonia.
- Statistical analysis included chi-square tests, calculation of sensitivity, specificity, positive and negative predictive values, and interobserver agreement (kappa statistics).
Main Results:
- Both the WHO score (score=1) and Khamapirad score (score>2) were significantly associated with bacterial pneumonia.
- The WHO method achieved a sensitivity of 85%, specificity of 51%, PPV of 30%, and NPV of 93%.
- Interobserver agreement was notably higher for the WHO scoring system compared to the Khamapirad score.
Conclusions:
- Both the WHO method and Khamapirad score demonstrate comparable accuracy in identifying bacterial pneumonia in young children.
- The WHO method is simpler to use and exhibits superior interobserver agreement, making it a potentially more practical tool.
- These findings support the utility of the WHO method for diagnosing bacterial pneumonia in pediatric populations.
Objective:
To evaluate the accuracy of World Health Organization (WHO) method of interpreting chest radiographs on identifying young children with bacterial pneumonia, and to compare its accuracy with other method.
Methods:
Chest radiographs from children aged under 5 years old hospitalized for pneumonia, with microbiological evidence of bacterial or viral infection, were evaluated by 3 observers blinded to other data (pediatrician [P], pulmonologist [N], radiologist [R]) according to WHO and Khamapirad scores. A WHO score=1 and a Khamapirad score >2 were selected as the thresholds suggesting bacterial pneumonia. The relationship between radiographic scores and etiology was evaluated using chi square. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values for predicting bacterial pneumonia were calculated. Interobserver agreement (P vs. N vs. R) was calculated (kappa).
Results:
108 chest radiographs were evaluated (87 viral, 21 bacterial). WHO score= 1 was associated with bacterial pneumonia (p <0.001; OR= 6.4; CI 95%= 1.629.7), achieving a Se= 85%, Sp= 51%, PPV= 30%, NPV= 93%. Khamapirad score >2, evaluated by P, was also associated with bacterial pneumonia (p <0.0008; OR= 6.31; CI 95%= 1.8-24.4), achieving a Se= 80%, Sp= 59%, PPV= 32% NPV= 92%. Interobserver agreement was slightly better using WHO score (P vs. N= 0.82, P vs. R= 0.69, N vs. R= 0.85) than Khamapirad score (P vs. N= 0.48, P vs. R= 0.69, N vs. R= 0.82).
Conclusions:
Both methods showed similar accuracy in order to identify bacterial pneumonia. WHO score is simpler than Khamapirad score and showed a better interobserver agreement.
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