Chest radiography of acute paediatric lower respiratory infections: experience versus interobserver variation

Abstract

Aim: To determine radiological and clinical chest radiographs (CRs) interpretation agreement in children with acute respiratory disease (ARD) versus clinical experience in multiple observers.

Methods: Chest radiographs obtained in 70 consecutive children at the emergency department in 2010-2011 for ARD were reviewed. They were interpreted by 1-10 paediatric residents, three board-certified paediatricians (BCPs), three paediatric pulmonologists and one paediatric radiologist. Chest radiographs were analysed for presence of 10 radiological features and five diagnoses. A short clinical and laboratory context was given. Each child was given a clinical decision. Statistical analysis was by Fleiss' kappa for multiple observers.

Results: Kappas by selected major diagnostic features and by observer experience were expressed relative to diagnosis by paediatric radiologist. Best agreements were for pleural effusion and pneumonia and worst for normal X-ray, hyperinflation and atelectasis. Years of experience were influential. Antibiotics for pneumonia diagnosed by radiologist would not have been prescribed in 23% of cases by residents, 25% by BCPs and 15% by pulmonologists.

Conclusion: In ARD in children, there is little interobserver agreement, especially among residents, which may impact on major clinical decision. There is a need to systematically train physicians in CRs reading.