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      Accuracy of the Interpretation of Chest Radiographs for the Diagnosis of Paediatric Pneumonia

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          Abstract

          Introduction

          World Health Organization (WHO) radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia.

          Methods

          An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification.

          Results

          There was significant disagreement (22%) between the first and second reports (kappa = 0.70, P<0.001), notably in those aged <5 years (26%, kappa = 0.66, P<0.001). The most frequent sources of disagreement were the reporting of patchy and perihilar changes.

          Conclusion

          This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children.

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          Most cited references17

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          The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America

          Abstract Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.
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            British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011.

            The British Thoracic Society first published management guidelines for community acquired pneumonia in children in 2002 and covered available evidence to early 2000. These updated guidelines represent a review of new evidence since then and consensus clinical opinion where evidence was not found. This document incorporates material from the 2002 guidelines and supersedes the previous guideline document.
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              Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies.

              Although radiological pneumonia is used as an outcome measure in epidemiological studies, there is considerable variability in the interpretation of chest radiographs. A standardized method for identifying radiological pneumonia would facilitate comparison of the results of vaccine trials and epidemiological studies of pneumonia. A WHO working group developed definitions for radiological pneumonia. Inter-observer variability in categorizing a set of 222 chest radiographic images was measured by comparing the readings made by 20 radiologists and clinicians with a reference reading. Intra-observer variability was measured by comparing the initial readings of a randomly chosen subset of 100 radiographs with repeat readings made 8-30 days later. Of the 222 images, 208 were considered interpretable. The reference reading categorized 43% of these images as showing alveolar consolidation or pleural effusion (primary end-point pneumonia); the proportion thus categorized by each of the 20 readers ranged from 8% to 61%. Using the reference reading as the gold standard, 14 of the 20 readers had sensitivity and specificity of > 0.70 in identifying primary end-point pneumonia; 13 out of 20 readers had a kappa index of > 0.6 compared with the reference reading. For the 92 radiographs deemed to be interpretable among the 100 images used for intra-observer variability, 19 out of 20 readers had a kappa index of > 0.6. Using standardized definitions and training, it is possible to achieve agreement in identifying radiological pneumonia, thus facilitating the comparison of results of epidemiological studies that use radiological pneumonia as an outcome.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                22 August 2014
                : 9
                : 8
                : e106051
                Affiliations
                [1 ]Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
                [2 ]Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
                [3 ]Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
                [4 ]Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
                [5 ]Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom
                [6 ]Regional Epidemiology Unit, Public Health England North East, Newcastle upon Tyne, United Kingdom
                [7 ]Department of Paediatrics, Sunderland Royal Hospital, Sunderland, United Kingdom
                [8 ]Department of Paediatrics, James Cook University Hospital, Middlesbrough, United Kingdom
                [9 ]Department of Paediatric Infectious Disease, Royal Children’s Hospital, Brisbane, Queensland, Australia
                Weill Medical College of Cornell University, United States of America
                Author notes

                Competing Interests: JEC and DAS received unconditional research support from Pfizer. The remaining authors declare no competing financial interests. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: JEC DAS. Wrote the paper: MAE. Developed the original study concept: JEC DAS. Performed statistical analysis: MAE. Provided guidance on statistical analysis: SPR RG. Reviewed all chest radiographs: MM. Reviewed the manuscript: MFT KME FH ARG. Collected and managed the data: MAE. Edited the manuscript: JEC DAS.

                Article
                PONE-D-14-08881
                10.1371/journal.pone.0106051
                4141860
                25148361
                ec6b1945-1d9e-4c6f-85a3-a0fb2248febd
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 February 2014
                : 29 July 2014
                Page count
                Pages: 5
                Funding
                The authors declare that this study was supported by a grant (No: 0887X1-4479) from Pfizer Vaccines UK. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Diagnostic Medicine
                Diagnostic Radiology
                Bone Imaging
                X-Ray Radiography
                Pulmonary Imaging
                Pediatrics
                Pediatric Pulmonology
                Pulmonology
                Radiology and Imaging

                Uncategorized
                Uncategorized

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