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Chest radiography of acute paediatric lower respiratory infections: experience versus interobserver variation
Yoel Levinsky1, Francis B Mimouni, Drora Fisher
1Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Interpreting pediatric chest radiographs for acute respiratory disease shows low agreement among physicians, particularly residents. This variability can affect clinical decisions, highlighting a need for standardized training in radiograph interpretation.
Area of Science:
- Pediatric Radiology
- Respiratory Medicine
- Medical Education
Background:
- Acute respiratory disease (ARD) in children necessitates accurate interpretation of chest radiographs (CRs).
- Variability in CR interpretation can impact clinical management and patient outcomes.
Purpose of the Study:
- To assess the agreement in interpreting pediatric CRs for ARD among healthcare professionals with varying clinical experience.
- To evaluate the influence of observer experience on diagnostic accuracy and clinical decision-making.
Main Methods:
- A review of CRs from 70 children with ARD was conducted.
- Multiple observers, including pediatric residents, pediatricians, pulmonologists, and a radiologist, interpreted the CRs.
- Statistical analysis using Fleiss' kappa was employed to determine interobserver agreement.
Main Results:
- Agreement was highest for pleural effusion and pneumonia, and lowest for normal X-rays, hyperinflation, and atelectasis.
- Physician experience significantly influenced interpretation agreement.
- A notable percentage of pneumonia diagnoses by radiologists would not have led to antibiotic prescription by residents (23%), BCPs (25%), or pulmonologists (15%).
Conclusions:
- There is limited interobserver agreement in CR interpretation for pediatric ARD, particularly among residents.
- This lack of agreement can significantly affect critical clinical decisions.
- Systematic training in CR reading is essential for improving diagnostic consistency.
Aim:
To determine radiological and clinical chest radiographs (CRs) interpretation agreement in children with acute respiratory disease (ARD) versus clinical experience in multiple observers.
Methods:
Chest radiographs obtained in 70 consecutive children at the emergency department in 2010-2011 for ARD were reviewed. They were interpreted by 1-10 paediatric residents, three board-certified paediatricians (BCPs), three paediatric pulmonologists and one paediatric radiologist. Chest radiographs were analysed for presence of 10 radiological features and five diagnoses. A short clinical and laboratory context was given. Each child was given a clinical decision. Statistical analysis was by Fleiss' kappa for multiple observers.
Results:
Kappas by selected major diagnostic features and by observer experience were expressed relative to diagnosis by paediatric radiologist. Best agreements were for pleural effusion and pneumonia and worst for normal X-ray, hyperinflation and atelectasis. Years of experience were influential. Antibiotics for pneumonia diagnosed by radiologist would not have been prescribed in 23% of cases by residents, 25% by BCPs and 15% by pulmonologists.
Conclusion:
In ARD in children, there is little interobserver agreement, especially among residents, which may impact on major clinical decision. There is a need to systematically train physicians in CRs reading.
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