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Associating a standardized reporting tool for chest radiographs with clinical complications in pediatric acute chest
Kerry Morrone1, Mihai Andreca2, Ellen J Silver1
1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
A new standardized tool improved radiologist agreement for interpreting pediatric acute chest syndrome (ACS) chest radiographs in sickle cell disease (SCD). Findings like left lower lobe opacity and pleural effusion indicate higher complication risks.
Area of Science:
- Radiology
- Pediatric Medicine
- Hematology
Background:
- Acute Chest Syndrome (ACS) is a significant cause of illness in pediatric sickle cell disease (SCD).
- A standardized reporting tool for chest radiographs in pediatric SCD patients was previously unavailable.
Purpose of the Study:
- To assess interobserver agreement among pediatric radiologists using a new standardized reporting tool for ACS chest radiographs.
- To investigate the relationship between radiographic findings and ACS complications in pediatric patients.
Main Methods:
- Retrospective cohort study of 127 pediatric ACS admissions.
- Two radiologists independently interpreted chest radiographs using a standardized tool; discrepancies were adjudicated.
- Interobserver agreement was analyzed using kappa (κ) statistics; clinical outcomes were correlated with radiographic findings.
Main Results:
- Moderate to near-perfect interobserver agreement was achieved with the standardized tool.
- Specific findings like left lower lobe opacity correlated with pediatric intensive care unit transfer.
- Pleural effusion was associated with increased need for blood products and noninvasive ventilation.
Conclusions:
- The standardized reporting tool demonstrates effective interobserver agreement among radiologists.
- Left lower lobe opacity and pleural effusion on initial chest radiographs are linked to increased ACS complications in pediatric SCD patients.
Background:
Acute chest syndrome (ACS) is an important cause of morbidity in sickle cell disease (SCD). A standardized tool for reporting chest radiographs in pediatric SCD patients did not previously exist.
Objective:
To analyze the interobserver agreement among pediatric radiologists' interpretations for pediatric ACS chest radiographs utilizing a standardized reporting tool. We also explored the association of radiographic findings with ACS complications.
Methods:
This was a retrospective cohort study of pediatric ACS admissions from a single institution in 2019. ICD-10 codes identified 127 ACS admissions. Two radiologists independently interpreted the chest radiographs utilizing a standardized reporting tool, a third radiologist adjudicated discrepancies, and κ analysis assessed interobserver agreement. Clinical outcomes were correlated with chest radiograph findings utilizing Pearsons' χ2 , t tests, and Mann-Whitney U tests. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
Results:
Interobserver agreement was moderate to near-perfect across variables, with κ analysis showing near-perfect agreement for opacity reported in the right upper lobe (0.84), substantial agreement for right lower lobe (0.63), and vertebral bony changes (0.72), with moderate agreement for all other reported variables. On the initial chest radiograph, an opacity located in the left lower lobe (LLL) correlated with pediatric intensive care unit transfer (p = .03). Pleural effusion on the initial chest radiograph had a 3.98 OR (95% CI: 1.35-11.74) of requiring blood products and a 10.67 OR (95% CI: 3.62-31.39) for noninvasive ventilation.
Conclusion:
The standardized reporting tool showed moderate to near-perfect agreement between radiologists. LLL opacity, and pleural effusion were associated with increased risk of ACS complications.
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