Rehan V K, Seshia M M, Johnston B, Reed M, Wilmot D, Cook V
Health Sciences Centre, Winnipeg, Manitoba, Canada.
Clin Pediatr (Phila). 1999 Nov;38(11):637-43. doi: 10.1177/000992289903801102.
We examined (1) the observer variability (both interobserver and intraobserver) in interpretation of abdominal radiographs of infants with suspected necrotizing enterocolitis (NEC), (2) the interobserver variability for individual radiologic signs used to diagnose NEC, and (3) the influence of experience in determining the extent of observer variability. Our hypotheses were (1) there would be considerable observer variability in interpretation of abdominal radiographs of infants with suspected NEC; (2) the extent of observer variability would differ for individual radiologic signs of NEC; and (3) the extent of observer variability would be determined by the observer's experience. The participants included 12 observers: two pediatric radiologists, four attending neonatologists, three neonatal fellows, and three pediatric residents. The participating observers under similar interpretation conditions, twice independently, interpreted the same 40 pairs of abdominal radiographs from infants with suspected NEC. The interval between the two interpretations was 3 to 6 months. Intraobserver and interobserver variability was assessed by applying the Kappa statistic to the radiologic signs of NEC for the two separate interpretations. The observers were blinded to patient's identity and the clinical course. Each observer recorded the absence, suspicion, or presence of (1) intestinal distention, (2) air fluid levels, (3) bowel wall thickening, (4) pneumatosis intestinalis, (5) portal venous gas, (6) pneumoperitoneum, and (7) NEC. We found low intraobserver and interobserver agreements. There was considerable variation in observer variability for individual radiologic signs. Trained observers performed better than intraining observers. We conclude that the radiologic signs in isolation should not be considered reliable. We recommend studies to formulate more objective criteria for many of the radiographic features of NEC. Standardization and periodic enforcement of these criteria among observers could reduce observer variability. We suggest that, to decrease both false-negative and false-positive interpretation, an experienced observer should always review the radiographs of infants with suspected NEC.
（1）在解读疑似坏死性小肠结肠炎（NEC）婴儿的腹部X线片时观察者的变异性（包括观察者间和观察者内）；（2）用于诊断NEC的各个放射学征象的观察者间变异性；（3）经验对确定观察者变异性程度的影响。我们的假设是：（1）在解读疑似NEC婴儿的腹部X线片时会存在相当大的观察者变异性；（2）NEC各个放射学征象的观察者变异性程度会有所不同；（3）观察者变异性程度将由观察者的经验决定。参与者包括12名观察者：两名儿科放射科医生、四名新生儿科主治医生、三名新生儿科住院医师和三名儿科住院医生。参与的观察者在相似的解读条件下，两次独立地解读了来自疑似NEC婴儿的相同40对腹部X线片。两次解读之间的间隔为3至6个月。通过将Kappa统计量应用于两次单独解读的NEC放射学征象来评估观察者内和观察者间的变异性。观察者对患者身份和临床病程不知情。每位观察者记录（1）肠扩张、（2）气液平面、（3）肠壁增厚、（4）肠壁积气、（5）门静脉积气、（6）气腹和（7）NEC的缺失、可疑或存在情况。我们发现观察者内和观察者间的一致性较低。各个放射学征象的观察者变异性存在相当大的差异。训练有素的观察者比正在培训的观察者表现更好。我们得出结论，单独的放射学征象不应被认为是可靠的。我们建议开展研究，为NEC的许多影像学特征制定更客观的标准。在观察者之间对这些标准进行标准化和定期强化可以减少观察者变异性。我们建议，为了减少假阴性和假阳性解读，应由经验丰富的观察者始终对疑似NEC婴儿的X线片进行复查。
