Interobserver agreement in interpretation of chest radiographs for pediatric community acquired pneumonia: Findings of the pedCAPNETZ-cohort

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Gesche M. Voigt - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Airway Research Center North (ARCN) - DZL Borstel (Author)
  • Dominik Thiele - , Airway Research Center North (ARCN) - DZL Borstel, Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Martin Wetzke - , Airway Research Center North (ARCN) - DZL Borstel, Hannover Medical School (MHH) (Author)
  • Jürgen Weidemann - , Children's and Youth Hospital auf der Bult (Author)
  • Patricia Maria Parpatt - , Klinikum Oldenburg (Author)
  • Tobias Welte - , Airway Research Center North (ARCN) - DZL Borstel, Hannover Medical School (MHH) (Author)
  • Jürgen Seidenberg - , University of Oldenburg (Author)
  • Christian Vogelberg - , University Medicine (Faculty of Medicine and University Hospital), Department of Paediatrics (Author)
  • Holger Koster - , University of Oldenburg (Author)
  • Gernot G.U. Rohde - , Airway Research Center North (ARCN) - DZL Borstel, University Hospital Frankfurt (Author)
  • Christoph Härtel - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck, University of Würzburg (Author)
  • Gesine Hansen - , Airway Research Center North (ARCN) - DZL Borstel, Hannover Medical School (MHH) (Author)
  • Matthias V. Kopp - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Airway Research Center North (ARCN) - DZL Borstel, University of Bern (Author)

Abstract

Although chest radiograph (CXR) is commonly used in diagnosing pediatric community acquired pneumonia (pCAP), limited data on interobserver agreement among radiologists exist. PedCAPNETZ is a prospective, observational, and multicenter study on pCAP. N = 233 CXR from patients with clinical diagnosis of pCAP were retrieved and n = 12 CXR without pathological findings were added. All CXR were interpreted by a radiologist at the site of recruitment and by two external, blinded pediatric radiologists. To evaluate interobserver agreement, the reporting of presence or absence of pCAP in CXR was analyzed, and prevalence and bias-adjusted kappa (PABAK) statistical testing was applied. Overall, n = 190 (82%) of CXR were confirmed as pCAP by two external pediatric radiologists. Compared with patients with pCAP negative CXR, patients with CXR-confirmed pCAP displayed higher C-reactive protein levels and a longer duration of symptoms before enrollment (p <.007). Further parameters, that is, age, respiratory rate, and oxygen saturation showed no significant difference. The interobserver agreement between the onsite radiologists and each of the two independent pediatric radiologists for the presence of pCAP was poor to fair (69%; PABAK = 0.39% and 76%; PABAK = 0.53, respectively). The concordance between the external radiologists was fair (81%; PABAK = 0.62). With regard to typical CXR findings for pCAP, chance corrected interrater agreement was highest for pleural effusions, infiltrates, and consolidations and lowest for interstitial patterns and peribronchial thickening. Our data show a poor interobserver agreement in the CXR-based diagnosis of pCAP and emphasized the need for harmonized interpretation standards.

Details

Original languageEnglish
Pages (from-to)2676-2685
Number of pages10
JournalPediatric pulmonology
Volume56
Issue number8
Publication statusPublished - Aug 2021
Peer-reviewedYes

External IDs

PubMed 34076967

Keywords

Keywords

  • antibiotic therapy, imaging, infections: pneumonia, TB, viral