Bramley Anna M, Chaves Sandra S, Dawood Fatimah S, Doshi Saumil, Reingold Arthur, Miller Lisa, Yousey-Hindes Kimberly, Farley Monica M, Ryan Patricia, Lynfield Ruth, Baumbach Joan, Zansky Shelley, Bennett Nancy, Thomas Ann, Schaffner William, Finelli Lyn, Jain Seema
Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA.
California Emerging Infections Program, Oakland, CA.
Public Health Rep. 2016 May-Jun;131(3):483-90. doi: 10.1177/003335491613100314.
Transcripts from admission chest radiographs could aid in identification of pneumonia cases for public health surveillance. We assessed the reliability of radiographic data abstraction and performance of radiographic key terms to identify pneumonia in patients hospitalized with laboratory-confirmed influenza virus infection.
We used data on patients hospitalized with laboratory-confirmed influenza virus infection from October 2008 through December 2009 from 10 geographically diverse U.S. study sites participating in the Influenza Hospitalization Surveillance Network (FluSurv-NET). Radiographic key terms (i.e., bronchopneumonia, consolidation, infiltrate, airspace density, and pleural effusion) were abstracted from final impressions of chest radiograph reports. We assessed the reliability of radiographic data abstraction by examining the percent agreement and Cohen's k statistic between clinicians and surveillance staff members. Using a composite reference standard for presence or absence of pneumonia based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and discharge summary data, we calculated sensitivity, specificity, positive predictive value (PPV), and percent agreement for individual and combined radiographic key terms.
For each radiographic key term, the percent agreement between clinicians and surveillance staff members ranged from 89.4% to 98.6% and Cohen's k ranged from 0.46 (moderate) to 0.84 (almost perfect). The combination of bronchopneumonia or consolidation or infiltrate or airspace density terms had sensitivity of 66.5%, specificity of 89.2%, PPV of 80.4%, and percent agreement of 80.1%. Adding pleural effusion did not result in significant changes in sensitivity, specificity, PPV, or percent agreement.
Radiographic key terms abstracted by surveillance staff members from final impressions of chest radiograph reports had moderate to almost perfect reliability and could be used to identify pneumonia among patients hospitalized with laboratory-confirmed influenza virus infection. This method can inform pneumonia surveillance and aid in public health response.
入院胸部X光片的记录有助于识别用于公共卫生监测的肺炎病例。我们评估了X光片数据提取的可靠性以及X光片关键术语在识别实验室确诊的流感病毒感染住院患者肺炎方面的表现。
我们使用了2008年10月至2009年12月期间来自美国10个地理位置不同的参与流感住院监测网络（FluSurv-NET）的研究地点的实验室确诊流感病毒感染住院患者的数据。X光片关键术语（即支气管肺炎、实变、浸润、气腔密度和胸腔积液）从胸部X光片报告的最终诊断中提取。我们通过检查临床医生和监测工作人员之间的一致百分比和科恩kappa统计量来评估X光片数据提取的可靠性。使用基于《国际疾病分类，第九次修订版，临床修订本》（ICD-9-CM）编码和出院小结数据的肺炎存在与否的综合参考标准，我们计算了各个和组合的X光片关键术语的敏感性、特异性、阳性预测值（PPV）和一致百分比。
对于每个X光片关键术语，临床医生和监测工作人员之间的一致百分比范围为89.4%至98.6%，科恩kappa范围为0.46（中等）至0.84（几乎完美）。支气管肺炎或实变或浸润或气腔密度术语的组合敏感性为66.5%，特异性为89.2%，PPV为80.4%，一致百分比为80.1%。添加胸腔积液并未导致敏感性、特异性、PPV或一致百分比的显著变化。
监测工作人员从胸部X光片报告的最终诊断中提取的X光片关键术语具有中等至几乎完美的可靠性，可用于识别实验室确诊的流感病毒感染住院患者中的肺炎。这种方法可为肺炎监测提供信息并有助于公共卫生应对。
