Document Detail

Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children.
MedLine Citation:
PMID:  8823854     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: This study was conducted to determine the reliability of detecting features and making diagnoses of lower respiratory infections from chest radiograms in young infants. METHODS: Forty chest radiograms of infants younger than 6 months of age admitted with lower respiratory tract infection to a tertiary care pediatric hospital were independently reviewed on two separate occasions by three pediatric radiologists blinded to the patients' clinical diagnoses. For each radiograph the radiologists noted whether a feature was present, absent or equivocal on a standardized form. The features examined were hyperinflation, peribronchial thickening, perihilar linear opacities, atelectasis and consolidation. On the same form each radiologist indicated whether the radiograph was normal or showed airways and/or airspace disease. Within and between observer agreement were calculated by the average weighted kappa statistic. RESULTS: Within observer agreement for the radiologic features of hyperinflation, peribronchial wall thickening, perihilar linear opacities, atelectasis and consolidation were 0.85, 0.76, 0.87, 0.86 and 0.91, respectively. The between observer kappa results for these features were 0.83, 0.55, 0.82, 0.78 and 0.79, respectively. The within and between observer kappa statistics for interpretation of the radiographic features were best for airspace disease (within, 0.92; between, 0.91), and lower for normal (within, 0.80; between, 0.66) radiogram and for airways disease (within, 0.68; between, 0.48). The presence of consolidation was highly correlated with a diagnosis of airspace disease by all three radiologists. CONCLUSIONS: Clinicians basing the diagnosis of lower respiratory infections in young infants on radiographic diagnosis should be aware that there is variation in intraobserver and interobserver agreement among radiologists on the radiographic features used for diagnosis. There is also variation in how specific radiologic features are used in interpreting the radiogram. However, the cardial finding of consolidation for the diagnosis of pneumonia appears to be highly reliable.
H D Davies; E E Wang; D Manson; P Babyn; B Shuckett
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Pediatric infectious disease journal     Volume:  15     ISSN:  0891-3668     ISO Abbreviation:  Pediatr. Infect. Dis. J.     Publication Date:  1996 Jul 
Date Detail:
Created Date:  1996-12-13     Completed Date:  1996-12-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8701858     Medline TA:  Pediatr Infect Dis J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  600-4     Citation Subset:  IM    
Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Ontario, Canada.
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MeSH Terms
Bronchiolitis / physiopathology,  radiography
Evaluation Studies as Topic
Observer Variation
Pneumonia / physiopathology,  radiography
Reproducibility of Results*
Respiratory Tract Infections / diagnosis,  physiopathology,  radiography*
Sensitivity and Specificity
Comment In:
Pediatr Infect Dis J. 1997 Jan;16(1):85-6   [PMID:  9002115 ]

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