Seear Michael, Awasthi Shally, Gowraiah Vishwanath, Kapoor Rashmi, Awasthi Aradhana, Verma Anilkumar, Al-Shabibi Saud, Gowdy Claire
Division of Respiratory Medicine, British Columbia's Children's Hospital, Room 1C31, Children's Hospital, Vancouver, BC, V6H 3V4, Canada.
Department of Pediatrics, King George's Medical University, Lucknow, India.
Indian J Pediatr. 2016 Sep;83(9):930-6. doi: 10.1007/s12098-016-2057-7. Epub 2016 Mar 3.
To test the predictive accuracy and reporting reproducibility of digital chest radiographs under low-resource conditions.
One hundred thirty four tachypneic children who presented to two Indian hospitals were enrolled. Based on review of 16 variables recorded in the Emergency Room (ER) by a senior pediatrician, children were given one of the four clinical diagnoses: pneumonia, wheezy disease, mixed and non-respiratory. Every child also had a digital CXR. It was interpreted by ER physician, pediatrician and two independent radiologists. All used the same standardized interpretation system (one or more of: normal, minor patches, major patches, hyperinflation, lobar change, pleural effusion).
The 10 % of CXRs showing pleural effusions reliably predicted pneumonia and disease severity. For all other CXR findings, the correlation between CXR interpretation and clinical diagnosis was moderate to poor. Apart from pleural effusions, inter-observer agreements between interpretations made by ER physician, pediatrician and radiologist were also poor (kappa <0.4).
With the exception of pleural effusions, CXR findings, interpreted by a radiologist, had moderate to poor power to predict respiratory diagnosis or disease severity defined by a pediatrician. Value of CXRs was further reduced by poor inter-observer agreement. When investigating tachypneic children under low-resource conditions, CXRs should be used with a clear understanding of their limitations.
测试低资源条件下数字胸部X光片的预测准确性和报告可重复性。
招募了134名到两家印度医院就诊的呼吸急促儿童。根据一名资深儿科医生对急诊室（ER）记录的16个变量的审查，将儿童分为四种临床诊断之一：肺炎、喘息性疾病、混合型和非呼吸道疾病。每个儿童还进行了一次数字胸部X光检查。由急诊室医生、儿科医生和两名独立放射科医生进行解读。所有人都使用相同的标准化解读系统（正常、小片状阴影、大片状阴影、肺过度充气、肺叶改变、胸腔积液中的一种或多种）。
10%显示胸腔积液的胸部X光片能可靠地预测肺炎和疾病严重程度。对于所有其他胸部X光检查结果，胸部X光片解读与临床诊断之间的相关性为中等至较差。除胸腔积液外，急诊室医生、儿科医生和放射科医生之间的观察者间一致性也较差（kappa<0.4）。
除胸腔积液外，放射科医生解读的胸部X光检查结果对预测儿科医生定义的呼吸诊断或疾病严重程度的能力为中等至较差。观察者间一致性差进一步降低了胸部X光片的价值。在低资源条件下对呼吸急促儿童进行调查时，使用胸部X光片时应清楚了解其局限性。
