Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study
Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study
复制标题
DOI：
10.1093/cid/cix082
复制
发表时间：
2017-06-15
影响因子：
11.8
通讯作者：
O'Brien, Katherine L.
中科院分区：
文献类型：
--
作者：
Fancourt, Nicholas;Knoll, Maria Deloria;O'Brien, Katherine L.
背景胸片（CXRs）是肺炎流行病学研究中有价值的诊断工具。世界卫生组织（WHO）用于解释儿科CXR的方法学尚未对其作为细菌疫苗试验终点指标的预期应用进行评价。儿童健康肺炎病原学研究（PERCH）研究招募了来自7个低收入和中等收入国家的1-59个月因WHO定义的重度和极重度肺炎住院的儿童。解释过程将每个CXR归类为5个结论中的1个：巩固、其他渗透、巩固和其他渗透、正常或无法解释。由14人组成的阅读小组中的两名成员对每份CXR进行解读，他们接受了CXR解读的培训和标准化。仲裁小组的两名成员对CXR进行了额外的独立审查，在主要阅读时存在不一致的解释，对既往报告设盲。通过协商一致的讨论解决了进一步的不一致。从4232例病例中共获得4172例CXR。观察到主要阅片人之间检测实变（有或无其他浸润）的一致性为78%（kappa = 0.50），仲裁员之间为84%（kappa = 0.61）;主要阅片人和仲裁员在5个结论类别中的一致性分别为43.5%（kappa = 0.25）和48.5%（kappa = 0.32）。阅读组和仲裁组的其他浸润和正常结论之间的不一致最常见（分别占不一致CXR的32%和30%）。协议是类似的，以前的评价使用世卫组织的方法检测巩固，但穷人的其他浸润，尽管试图在一个严格的标准化过程。
Background. Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials.Methods. The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1-59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low-and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion.Results. A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (kappa = 0.50) and between arbitrators was 84% (kappa = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (kappa = 0.25) and 48.5% (kappa = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively).Conclusions. Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process.