Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies

Thomas Cherian, E. Kim Mulholland, John B. Carlin, Harald Ostensen, Ruhul Amin, Margaret De Campo, David Greenberg, Rosanna Lagos, Marilla Lucero, Shabir A. Madhi, Katherine L. O'Brien, Steven Obaro, Mark C. Steinhoff

    Research output: Contribution to journalArticlepeer-review

    534 Scopus citations

    Abstract

    Background: Although radiological pneumonia is used as an outcome measure in epidemiological studies, there is considerable variability in the interpretation of chest radiographs. A standardized method for identifying radiological pneumonia would facilitate comparison of the results of vaccine trials and epidemiological studies of pneumonia. Methods: A WHO working group developed definitions for radiological pneumonia. Inter-observer variability in categorizing a set of 222 chest radiographic images was measured by comparing the readings made by 20 radiologists and clinicians with a reference reading. Intra-observer variability was measured by comparing the initial readings of a randomly chosen subset of 100 radiographs with repeat readings made 8-30 days later. Findings: Of the 222 images, 208 were considered interpretable. The reference reading categorized 43% of these images as showing alveolar consolidation or pleural effusion (primary end-point pneumonia); the proportion thus categorized by each of the 20 readers ranged from 8% to 61%. Using the reference reading as the gold standard, 14 of the 20 readers had sensitivity and specificity of ≥ 0.70 in identifying primary end-point pneumonia; 13 out of 20 readers had a kappa index of > 0.6 compared with the reference reading. For the 92 radiographs deemed to be interpretable among the 100 images used for intra-observer variability, 19 out of 20 readers had a kappa index of > 0.6. Conclusion: Using standardized definitions and training, it is possible to achieve agreement in identifying radiological pneumonia, thus facilitating the comparison of results of epidemiological studies that use radiological pneumonia as an outcome.

    Original languageEnglish
    Pages (from-to)353-359
    Number of pages7
    JournalBulletin of the World Health Organization
    Volume83
    Issue number5
    StatePublished - 1 May 2005

    Keywords

    • Child
    • Observer variation
    • Pneumonia/radiography
    • Radiography, Thoracic/standards
    • Reference standards
    • Sensitivity and specificity

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health

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