Melbye H, Dale K
Institute of Community Medicine, University Hospital of Tromsø, Norway.
Acta Radiol. 1992 Jan;33(1):79-81.
Acute chest radiographs were obtained from 319 adult patients with acute respiratory infections. Where a lower respiratory infection was diagnosed, follow-up chest radiographs were obtained in most patients. A radiologic panel diagnosed pneumonia in 21 patients. The agreements between the panel and 3 independent interpreters, 2 residents in radiology, and one senior chest physician, were assessed. Also the reports given by the specialist in radiology at the Department of Radiology were compared with the panel's evaluation. While the kappa-agreements between the panel's interpretations and those by the Department of Radiology and the consultant in chest medicine was 0.71 and 0.72, respectively, the corresponding kappa-values between the residents and the panel was only 0.50. The proportion of agreement when pneumonia was diagnosed was 0.56 between the panel and the Department of Radiology, and 0.59 between the panel and the chest consultant, compared to 0.36 between the panel and the residents. The study demonstrates the difficulty of diagnosing outpatient pneumonia and the importance of experience.
对319例患有急性呼吸道感染的成年患者进行了急性胸部X光检查。在诊断为下呼吸道感染的患者中，大多数患者都进行了后续胸部X光检查。一个放射学专家组诊断出21例肺炎患者。评估了该专家组与3名独立解读人员、2名放射科住院医师和1名资深胸科医生之间的一致性。同时，还将放射科专家给出的报告与专家组的评估进行了比较。专家组的解读与放射科以及胸科医学顾问的解读之间的kappa一致性分别为0.71和0.72，而住院医师与专家组之间的相应kappa值仅为0.50。在诊断为肺炎时，专家组与放射科之间的一致比例为0.56，与胸科顾问之间为0.59，而与住院医师之间为0.36。该研究表明了门诊肺炎诊断的困难以及经验的重要性。
