A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study
A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study
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DOI：
10.1186/s12880-015-0103-y
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发表时间：
2015-12-29
影响因子：
2.7
通讯作者：
Grant, Cameron C.
中科院分区：
文献类型：
--
作者：
Taylor, Emma;Haven, Kathryn;Grant, Cameron C.
背景：术语严重急性呼吸道感染（SARI）包括一组异质性呼吸道疾病。SARI的严重程度分级目前依赖于间接的疾病严重程度测量，如呼吸和心率，以及对氧气或重症监护的需要。由于肺部是SARI涉及的主要器官系统，胸部X线片（CXR）可能有助于描述疾病的严重程度。我们的目标是开发和验证一个SARI CXR严重程度评分system.Methods：我们完成了一个积极的SARI监测项目内的验证，与SARI定义使用世界卫生组织的急性呼吸道感染的病例定义与发热史，或测量发热>= 38摄氏度;和咳嗽，并在过去10天内发病，并需要住院治疗。我们随机选择了250例SARI病例。入院时CXR检查结果分为：1 =正常; 2 =斑片状肺不张和/或过度充气和/或支气管壁增厚; 3 =局灶性实变; 4 =多灶性实变; 5 =弥漫性肺泡改变。随后，一名儿科医生、一名内科医生、两名住院医生、两名医学生和一名研究护士对CXR报告进行独立评分。使用加权Kappa（kappa）确定观察者间可靠性，用于比较放射科医生、放射科医生和临床医生以及临床医生。一致性定义为中度（kappa > 0.4-0.6），良好结果：两名儿科放射科医师之间的一致性非常好（kappa = 0.83，95%CI 0.65-1.00），两名成人放射科医师之间的一致性良好（kappa = 0.75，95%CI 0.57- 0.01）。93).临床医生与放射科医生的一致性为中等至良好（儿科医生：Kappa = 0.65;儿科住院医师：Kappa= 0.69;内科医生：Kappa = 0.68;住院医师：Kappa = 0.67;研究护士：Kappa = 0.49，医学生：Kappa = 0.53和Kappa = 0.56）。临床医生之间的一致性为良好至非常好（儿科医生与内科医生：kappa = 0.85;儿科住院医师：kappa = 0.81;内科住院医师：kappa = 0.76;研究护士：kappa = 0.75;医学院学生：kappa = 0.63和0.66）。在临床医生对不一致的CXR报告评分进行审查后，放射科医师-临床医师一致性的kappa值范围为0.59 - 0.70，临床医师-临床医师一致性的kappa值范围为0.97 - 0.99。结论：这种五点CXR评分工具适用于资源匮乏和资源充足的环境，适用于不同经验水平的临床医生，可可靠地描述SARI的严重程度。由此产生的数字数据使不同国家和环境之间的SARI严重程度的流行病学比较。
Background: The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system.Methods: We completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of >= 38 degrees C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes.Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (kappa) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (kappa > 0.4-0.6), good (kappa > 0.6-0.8) and very good (kappa > 0.8-1.0).Results: Agreement between the two pediatric radiologists was very good (kappa = 0.83, 95 % CI 0.65-1.00) and between the two adult radiologists was good (kappa = 0.75, 95 % CI 0.57-0. 93).Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:kappa = 0.65; pediatric resident:kappa= 0.69; physician:kappa = 0.68; resident:kappa = 0.67; research nurse:kappa = 0.49, medical students:kappa = 0.53 and kappa = 0.56).Agreement between clinicians was good-to-very good (pediatrician vs. physician:kappa = 0.85; vs. pediatric resident:kappa = 0.81; vs. medicine resident:kappa = 0.76; vs. research nurse:kappa = 0.75; vs. medical students:kappa = 0.63 and 0.66).Following review of discrepant CXR report scores by clinician pairs,kappa values for radiologist-clinician agreement ranged from 0.59 to 0.70 and for clinician-clinician agreement from 0.97 to 0.99.Conclusions: This five-point CXR scoring tool, suitable for use in poorly-and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity. The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.