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Predictive Accuracy of Chest Radiographs in Diagnosing Tachypneic Children
Michael Seear1, Shally Awasthi2, Vishwanath Gowraiah3
1Division of Respiratory Medicine, British Columbia's Children's Hospital, Room 1C31, Children's Hospital, Vancouver, BC, V6H 3V4, Canada. mseear@cw.bc.ca.
Insights
Digital chest X-rays (CXRs) in low-resource settings had poor accuracy for diagnosing respiratory illnesses in children, except for pleural effusions. Inter-observer agreement was also low, limiting CXR utility.
Area of Science:
- Pediatric Radiology
- Global Health
Background:
- Digital chest radiography (CXR) is crucial for diagnosing pediatric respiratory conditions.
- Low-resource settings present unique challenges for accurate medical imaging interpretation.
Purpose of the Study:
- To evaluate the predictive accuracy of digital CXRs for respiratory diagnoses in children in low-resource environments.
- To assess the reproducibility of CXR interpretations among different healthcare professionals.
Main Methods:
- 134 tachypneic children in Indian hospitals underwent digital CXR.
- Clinical diagnoses were made by a senior pediatrician based on emergency room (ER) variables.
- CXR interpretations were performed by ER physicians, pediatricians, and radiologists using a standardized system.
Main Results:
- Pleural effusions on CXR reliably predicted pneumonia and disease severity (10% of cases).
- Correlation between other CXR findings and clinical diagnosis was moderate to poor.
- Inter-observer agreement for CXR interpretation was poor (kappa <0.4), except for pleural effusions.
Conclusions:
- Digital CXR findings, excluding pleural effusions, have limited power to predict pediatric respiratory diagnoses or severity in low-resource settings.
- Poor inter-observer agreement further diminishes the value of CXRs.
- Healthcare providers should use CXRs cautiously in low-resource settings, understanding their limitations.
Objective:
To test the predictive accuracy and reporting reproducibility of digital chest radiographs under low-resource conditions.
Methods:
One hundred thirty four tachypneic children who presented to two Indian hospitals were enrolled. Based on review of 16 variables recorded in the Emergency Room (ER) by a senior pediatrician, children were given one of the four clinical diagnoses: pneumonia, wheezy disease, mixed and non-respiratory. Every child also had a digital CXR. It was interpreted by ER physician, pediatrician and two independent radiologists. All used the same standardized interpretation system (one or more of: normal, minor patches, major patches, hyperinflation, lobar change, pleural effusion).
Results:
The 10 % of CXRs showing pleural effusions reliably predicted pneumonia and disease severity. For all other CXR findings, the correlation between CXR interpretation and clinical diagnosis was moderate to poor. Apart from pleural effusions, inter-observer agreements between interpretations made by ER physician, pediatrician and radiologist were also poor (kappa <0.4).
Conclusions:
With the exception of pleural effusions, CXR findings, interpreted by a radiologist, had moderate to poor power to predict respiratory diagnosis or disease severity defined by a pediatrician. Value of CXRs was further reduced by poor inter-observer agreement. When investigating tachypneic children under low-resource conditions, CXRs should be used with a clear understanding of their limitations.
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