Reliability and validity of the World Health Organization reading standards for paediatric chest radiographs used in the field in an impact study of Pneumococcal Conjugate Vaccine in Kilifi, Kenya
Reliability and validity of the World Health Organization reading standards for paediatric chest radiographs used in the field in an impact study of Pneumococcal Conjugate Vaccine in Kilifi, Kenya
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DOI：
10.1371/journal.pone.0200715
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发表时间：
2018-07-25
期刊：
影响因子：
3.7
通讯作者：
Scott, A.
中科院分区：
文献类型：
--
作者：
Ominde, M.;Sande, J.;Scott, A.
放射学确诊肺炎（RCP）是肺炎球菌结合疫苗（PCV）试验中用于评估疫苗效力的一个特定终点。然而，胸片（CXR）的解读在阅读器内部和阅读器之间是不同的。在一项关于PCV对肺炎影响的研究中，我们使用一致性百分比和Cohen’s Kappa测量儿科CXR解释的可重复性和可靠性，以及现场读数与专家评审的有效性。方法对2006年至2014年肯尼亚基利菲县医院收治的2716例临床诊断为重症或极重症肺炎的患儿进行scxrs采集。五名临床医生和放射科医生参加了为期三天的使用世卫组织标准的CXR口译培训课程。所有的cxr都由两个本地主读者阅读一次。不一致的读数和13%的一致读数由三名放射专家组成的小组进行仲裁。为了评估可重复性，中位数5%的随机样本出现了两次。根据仲裁人结果的“金标准”，对主要读者解释的敏感性和特异性进行了估计。结果2716例cxr中2例不可解释，159例两次评价。对于所有病理结果，RCP的一致性百分比和Kappa分别为89%和0.68，范围分别为84-97%和0.19-0.68。观察者内部的重复性是观察者之间的信度。主要阅读器检测RCP的灵敏度分别为69%和73%；特异性分别为96%和95%。结论在影像学确诊肺炎的解释上，观察员之间和观察员之间的共识是公平的。合理的敏感性和高特异性使实地确定的放射确诊肺炎成为衡量疫苗相对有效性的合适指标。
BackgroundRadiologically-confirmed pneumonia (RCP) is a specific end-point used in trials of Pneumococcal Conjugate Vaccine (PCV) to estimate vaccine efficacy. However, chest radiograph (CXR) interpretation varies within and between readers. We measured the repeatability and reliability of paediatric CXR interpretation using percent agreement and Cohen's Kappa and the validity of field readings against expert review in a study of the impact of PCV on pneumonia.MethodsCXRs were obtained from 2716 children admitted between 2006 and 2014 to Kilifi County Hospital, Kilifi, Kenya, with clinically-defined severe or very-severe pneumonia. Five clinicians and radiologists attended a three-day training course on CXR interpretation using a WHO standard. All CXRs were read once by two local primary readers. Discordant readings and 13% of concordant readings were arbitrated by a panel of three expert radiologists. To assess repeatability, a 5% median random sample was presented twice. Sensitivity and specificity of the primary readers' interpretations was estimated against the 'gold-standard' of the arbitrators' results.ResultsOf 2716 CXRs, 2 were uninterpretable and 159 were evaluated twice. The percent agreement and Kappa for RCP were 89% and 0.68 and ranged between 84-97% and 0.19-0.68, respectively, for all pathological findings. Intra-observer repeatability was inter observer reliability. Sensitivities of the primary readers to detect RCP were 69% and 73%; specificities were 96% and 95%.ConclusionIntra- and inter-observer agreements on interpretations of radiologically-confirmed pneumonia are fair to good. Reasonable sensitivity and high specificity make radiologically-confirmed pneumonia, determined in the field, a suitable measure of relative vaccine effectiveness.