Pediatric chest radiograph interpretation in a real-life setting

Area of Science:

• Pediatric Radiology
• Diagnostic Imaging
• Clinical Interpretation

Background:

• Inter-observer agreement for pediatric chest radiographs is fair to moderate.
• Previous studies often lacked real-world clinical settings.
• Clinical risk factors for interpretation discrepancies remain largely unreported.

Purpose of the Study:

• To assess agreement between emergency department pediatricians and radiologists for pediatric chest radiographs.
• To identify clinical risk factors contributing to interpretation discrepancies in a real-world setting.

Main Methods:

• 1373 pediatric chest radiographs from an emergency department were reviewed.
• Agreement was assessed using Cohen's kappa between pediatricians and radiologists.
• Multivariable logistic regression analyzed risk factors for disagreement.

Main Results:

• Moderate agreement (k=0.505) was observed between pediatricians and radiologists.
• Agreement was lower ('fair', k=0.391) for radiographs taken after midnight.
• Clinically relevant disagreements occurred in 18.9% of cases, leading to potential over- or under-treatment.

Conclusions:

• Moderate agreement exists between pediatricians and radiologists in interpreting chest radiographs.
• Neurological background, fever, dyspnea, and nighttime interpretation are significant risk factors for disagreement.
• Addressing these factors can optimize radiologist utilization and improve patient care.