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Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility
G Kaguthi1, V Nduba2, J Nyokabi3
1Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), Kisumu, Nairobi 40100, Kenya.
Insights
Interpreting pediatric chest radiographs for tuberculosis (TB) shows poor agreement among healthcare providers. This impacts the reliability of TB vaccine trials that use chest X-rays (CXRs) as endpoints.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Pediatrics
Background:
- Chest radiography (CXR) is crucial for diagnosing pediatric tuberculosis (TB) and evaluating TB vaccine trials.
- Accurate interpretation of CXRs is essential for effective patient management and reliable trial outcomes.
Purpose of the Study:
- To assess interrater agreement in diagnosing pediatric TB using CXRs in western Kenya.
- To evaluate the diagnostic performance of healthcare professionals with varying levels of training in pediatric CXR interpretation.
Main Methods:
- Pediatric pulmonologist/radiologist (experts), a medical officer (M.O), and four clinical officers (C.Os) blindly reviewed 691 infant CXRs.
- C.Os had access to clinical findings; agreement was measured using weighted kappa scores.
- Sensitivity and specificity were determined against microbiologically confirmed TB.
Main Results:
- Interrater agreement for TB-consistent abnormalities was poor (k=0.14); agreement for lymphadenopathy was moderate (k=0.26).
- Medical officers (75%) and C.Os (63%) demonstrated high sensitivity for culture-confirmed TB.
- C.Os, unblinded to clinical data, detected many confirmed cases, requiring cautious interpretation.
Conclusions:
- Poor interrater agreement in CXR interpretation challenges its use as a sole endpoint in pediatric TB vaccine trials.
- Relying on expert CXR agreement may lead to reduced specificity and underestimated vaccine efficacy.
- Further research is needed to standardize CXR interpretation and validate alternative diagnostic endpoints.
Abstract:
The chest radiograph (CXR) is considered a key diagnostic tool for pediatric tuberculosis (TB) in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts), a medical officer (M.O), and four clinical officers (C.Os) with basic training in pediatric CXR reading blindly assessed CXRs of infants who were TB suspects in a cohort study. C.Os had access to clinical findings for patient management. Weighted kappa scores summarized interrater agreement on lymphadenopathy and abnormalities consistent with TB. Sensitivity and specificity of raters were determined using microbiologically confirmed TB as the gold standard (n = 8). A total of 691 radiographs were reviewed. Agreement on abnormalities consistent with TB was poor; k = 0.14 (95% CI: 0.10-0.18) and on lymphadenopathy moderate k = 0.26 (95% CI: 0.18-0.36). M.O [75% (95% CI: 34.9%-96.8%)] and C.Os [63% (95% CI: 24.5%-91.5%)] had high sensitivity for culture confirmed TB. TB vaccine trials utilizing expert agreement on CXR as a nonmicrobiologically confirmed endpoint will have reduced specificity and will underestimate vaccine efficacy. C.Os detected many of the bacteriologically confirmed cases; however, this must be interpreted cautiously as they were unblinded to clinical features.
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