Do pediatric intensivists and radiologists concur on the interpretation of chest radiographs?

BACKGROUND

Therapeutic decisions in the pediatric intensive care unit are made by pediatric intensivists (PI) based on their interpretation of chest radiographs before the formal interpretation by a pediatric radiologist (PR). This study was designed to determine the adequacy of chest radiograph interpretations by pediatric intensivists and the effects on patient care. The PI recorded their chest radiograph interpretations, documenting support devices and thoracic abnormalities. Concordance and discordance were determined by the pediatric pulmonologist who was not involved in the care of the patient by comparing the interpretations of the PI and PR. Clinically significant discordance was defined as interpretations by the radiologist that differed to those from the PI that may have required therapeutic intervention. RESULTS: The evaluation of 291 chest radiographs demonstrated an overall concordance rate of 82.5% (240 out of 291; P < 0.05). There was no significant difference in the ability of critical care medicine physicians to identify atelectasis, infiltrates, pleural effusions, or airleaks (P > 0.05). Support devices were correctly identified in 100% of the cases. Discordant interpretations included 20 that were clinically significant, 17 insignificant findings and 14 films over-interpreted by the PI. A chart review of the patients with discordant findings revealed only one finding that required an alteration in therapy. CONCLUSIONS: These findings demonstrate significant agreement between the interpretation of chest radiographs by PI and PR in selected clinical situations. These data support the current practice of the PI making therapeutic decisions based on their interpretations of chest radiographs.