Interpretation of pediatric chest radiographs by non-radiologist clinicians in Botswana using World Health Organization criteria for endpoint pneumonia.
Interpretation of pediatric chest radiographs by non-radiologist clinicians in Botswana using World Health Organization criteria for endpoint pneumonia.
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DOI：
10.1007/s00247-020-04625-0
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发表时间：
2020-06
影响因子：
2.3
通讯作者：
Arscott-Mills T
中科院分区：
文献类型：
--
作者：
Fawole OA;Kelly MS;Steenhoff AP;Feemster KA;Crotty EJ;Rattan MS;David T;Mazhani T;Shah SS;Andronikou S;Arscott-Mills T
在低收入和中等收入国家，胸片最常由非放射科临床医生解读。我们检查了博茨瓦纳非放射科医生临床医生进行胸部X光片解读的可靠性，并进行了旨在提高非放射科医生临床医生胸部X光片解读准确性的教育干预。我们在博茨瓦纳哈博罗内的一家转诊医院招募了非放射科医生临床医生，来解读患有临床肺炎的儿童的去识别化胸片。我们将他们的解释与美国两名经过委员会认证的儿科放射科医生的解释进行了比较。我们使用逻辑回归和 kappa 统计评估了组间医疗培训水平与胸部 X 光检查结果准确性之间的关联。然后，我们制定了由儿科放射科医生领导的现场培训干预措施。我们要求参与者在干预前和干预后立即解读 20 张射线照片，并将他们的反应与协助放射科医生的反应进行比较。对于这两个目标，我们的主要结果是确定主要终点肺炎，世界卫生组织将其定义为存在终点实变或终点渗出。 22 名临床医生解读胸部 X 光片的主要目标；培训水平与终点肺炎的正确识别之间没有显着关联；受访者和放射科医生之间的一致性中等（κ=0.43）。培训干预后，参与者与协助放射科医生对终点肺炎的一致性从一般提高到中等（κ = 0.34 至 κ = 0.49）。博茨瓦纳的非放射科医生临床医生并不能一致地识别肺炎的关键胸部放射学检查结果。有针对性的培训干预可能会提高非放射科医生临床医生解读胸部X光片的能力。
In low- and middle-income countries, chest radiographs are most frequently interpreted by non-radiologist clinicians. We examined the reliability of chest radiograph interpretations performed by non-radiologist clinicians in Botswana and conducted an educational intervention aimed at improving chest radiograph interpretation accuracy among non-radiologist clinicians. We recruited non-radiologist clinicians at a referral hospital in Gaborone, Botswana, to interpret de-identified chest radiographs for children with clinical pneumonia. We compared their interpretations with those of two board-certified pediatric radiologists in the United States. We evaluated associations between level of medical training and the accuracy of chest radiograph findings between groups, using logistic regression and kappa statistics. We then developed an in-person training intervention led by a pediatric radiologist. We asked participants to interpret 20 radiographs before and immediately after the intervention, and we compared their responses to those of the facilitating radiologist. For both objectives, our primary outcome was the identification of primary endpoint pneumonia, defined by the World Health Organization as presence of endpoint consolidation or endpoint effusion. Twenty-two clinicians interpreted chest radiographs in the primary objective; there were no significant associations between level of training and correct identification of endpoint pneumonia; concordance between respondents and radiologists was moderate (κ=0.43). After the training intervention, participants improved agreement with the facilitating radiologist for endpoint pneumonia from fair to moderate (κ=0.34 to κ=0.49). Non-radiologist clinicians in Botswana do not consistently identify key chest radiographic findings of pneumonia. A targeted training intervention might improve non-radiologist clinicians’ ability to interpret chest radiographs.