[The chest x-ray in acute bronchiolitis: Technical quality, findings, and an assessment of its reliability]

Area of Science:

• Pediatric Pulmonology
• Diagnostic Imaging
• Clinical Epidemiology

Background:

• Chest x-rays are frequently used for infant acute bronchiolitis (AB) despite clinical guidelines recommending against it.
• Reproducibility studies on chest x-ray interpretation in AB are limited.
• This study evaluates radiograph quality, findings, and inter-observer agreement in infant AB.

Purpose of the Study:

• To assess the inter-observer agreement of chest x-ray findings in infants diagnosed with acute bronchiolitis (AB).
• To evaluate the reliability of chest x-rays as a diagnostic tool for infant AB.
• To identify factors influencing the agreement among medical professionals interpreting infant chest x-rays.

Main Methods:

• 140 chest x-rays from 281 infants with AB were reviewed.
• Twelve physicians evaluated 10 predefined radiological signs.
• Inter-observer agreement was analyzed using Cohen's kappa (2 observers) and Fleiss' kappa (≥3 observers).

Main Results:

• Only 8.5% of radiographs indicated complicated AB.
• Medium agreement (kappa: 0.20-0.40) was observed among groups of 3+ observers.
• Wider variability (kappa: -0.20-0.60) was found between pairs of observers, influenced by the specific sign, medical specialty, and experience.

Conclusions:

• Low inter-observer agreement and high variability indicate chest x-rays are unreliable for infant AB assessment.
• The findings do not support the routine use of chest x-rays in managing infants with AB.
• Clinical practice guidelines should be reinforced regarding the non-recommendation of chest x-rays for infant AB.