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. 2019 Apr 15;6(1):e000393.
doi: 10.1136/bmjresp-2018-000393. eCollection 2019.

Chest radiograph reading panel performance in a Bangladesh pneumococcal vaccine effectiveness study

Eric D McCollum  1   2   3 , Salahuddin Ahmed  4 , Nabidul H Chowdhury  4 , Syed J R Rizvi  4 , Ahad M Khan  4 , Arun D Roy  4 , Abu Am Hanif  4 , Farhan Pervaiz  5   6   7 , Asm Nawshad U Ahmed  8   9 , Ehteshamul H Farrukee  10 , Mahmuda Monowara  11 , Mohammad M Hossain  11 , Fatema Doza  12 , Bidoura Tanim  13 , Farzana Alam  14 , Nicole Simmons  3 , Megan E Reller  15   16   17 , Meagan Harrison  3 , Holly B Schuh  3 , Abdul Quaiyum  18 , Samir K Saha  9 , Nazma Begum  4 , Mathuram Santosham  3 , Lawrence H Moulton  5 , William Checkley  5   6   7 , Abdullah H Baqui  3
Affiliations

Chest radiograph reading panel performance in a Bangladesh pneumococcal vaccine effectiveness study

Eric D McCollum et al. BMJ Open Respir Res. .

Abstract

Introduction: To evaluate WHO chest radiograph interpretation processes during a pneumococcal vaccine effectiveness study of children aged 3-35 months with suspected pneumonia in Sylhet, Bangladesh.

Methods: Eight physicians masked to all data were standardised to WHO methodology and interpreted chest radiographs between 2015 and 2017. Each radiograph was randomly assigned to two primary readers. If the primary readers were discordant for image interpretability or the presence or absence of primary endpoint pneumonia (PEP), then another randomly selected, masked reader adjudicated the image (arbitrator). If the arbitrator disagreed with both primary readers, or concluded no PEP, then a masked expert reader finalised the interpretation. The expert reader also conducted blinded quality control (QC) for 20% of randomly selected images. We evaluated agreement between primary readers and between the expert QC reading and the final panel interpretation using per cent agreement, unadjusted Cohen's kappa, and a prevalence and bias-adjusted kappa.

Results: Among 9723 images, the panel classified 21.3% as PEP, 77.6% no PEP and 1.1% uninterpretable. Two primary readers agreed on interpretability for 98% of images (kappa, 0.25; prevalence and bias-adjusted kappa, 0.97). Among interpretable radiographs, primary readers agreed on the presence or absence of PEP in 79% of images (kappa, 0.35; adjusted kappa, 0.57). Expert QC readings agreed with final panel conclusions on the presence or absence of PEP for 92.9% of 1652 interpretable images (kappa, 0.75; adjusted kappa, 0.85).

Conclusion: Primary reader performance and QC results suggest the panel effectively applied the WHO chest radiograph criteria for pneumonia.

Keywords: Asia; child; developing countries; infant; pneumococcal vaccines; respiratory tract diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Projahnmo study area in Sylhet, Bangladesh.
Figure 2
Figure 2
Chest radiograph interpretation schema. Concordance indicates agreement on image interpretability and PEP. PEP, primary endpoint pneumonia.
Figure 3
Figure 3
(A) Interobserver agreement for interpretable versus uninterpretable chest radiographs among the eight individual primary readers. (B) Interobserver agreement for PEP versus no PEP chest radiographs among the eight individual primary readers. PEP, primary endpoint pneumonia.
Figure 4
Figure 4
(A) Intraobserver agreement for interpretable versus uninterpretable chest radiographs among the eight individual primary readers. (B) Intraobserver agreement for PEP versus no PEP chest radiographs among the eight individual primary readers. PEP, primary endpoint pneumonia.
See this image and copyright information in PMC

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