Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Radiol. 2020 Jun;50(7):913-922. doi: 10.1007/s00247-020-04625-0. Epub 2020 Jun 10.
In low- and middle-income countries, chest radiographs are most frequently interpreted by non-radiologist clinicians.
We examined the reliability of chest radiograph interpretations performed by non-radiologist clinicians in Botswana and conducted an educational intervention aimed at improving chest radiograph interpretation accuracy among non-radiologist clinicians.
We recruited non-radiologist clinicians at a referral hospital in Gaborone, Botswana, to interpret de-identified chest radiographs for children with clinical pneumonia. We compared their interpretations with those of two board-certified pediatric radiologists in the United States. We evaluated associations between level of medical training and the accuracy of chest radiograph findings between groups, using logistic regression and kappa statistics. We then developed an in-person training intervention led by a pediatric radiologist. We asked participants to interpret 20 radiographs before and immediately after the intervention, and we compared their responses to those of the facilitating radiologist. For both objectives, our primary outcome was the identification of primary endpoint pneumonia, defined by the World Health Organization as presence of endpoint consolidation or endpoint effusion.
Twenty-two clinicians interpreted chest radiographs in the primary objective; there were no significant associations between level of training and correct identification of endpoint pneumonia; concordance between respondents and radiologists was moderate (κ=0.43). After the training intervention, participants improved agreement with the facilitating radiologist for endpoint pneumonia from fair to moderate (κ=0.34 to κ=0.49).
Non-radiologist clinicians in Botswana do not consistently identify key chest radiographic findings of pneumonia. A targeted training intervention might improve non-radiologist clinicians' ability to interpret chest radiographs.
在中低收入国家，非放射科临床医生最常解读胸部 X 光片。
我们检查了博茨瓦纳非放射科临床医生进行的胸部 X 光片解读的可靠性，并进行了一项旨在提高非放射科临床医生胸部 X 光片解读准确性的教育干预。
我们招募了博茨瓦纳哈博罗内的一家转诊医院的非放射科临床医生，对患有临床肺炎的儿童进行匿名胸部 X 光片解读。我们将他们的解释与美国的两位经过董事会认证的儿科放射科医生的解释进行了比较。我们使用逻辑回归和 Kappa 统计评估了不同组之间医疗培训水平与胸部 X 光片结果准确性之间的关联。然后，我们开发了一种由儿科放射科医生领导的面对面培训干预措施。我们要求参与者在干预之前和之后立即解释 20 张 X 光片，并将他们的回答与促进放射科医生的回答进行比较。对于这两个目标，我们的主要结果是确定主要终点肺炎的识别，终点肺炎由世界卫生组织定义为存在终点实变或终点积液。
22 名临床医生在主要目标中解读了胸部 X 光片；培训水平与正确识别终点肺炎之间没有显著关联；受访者与放射科医生之间的一致性为中度（κ=0.43）。在培训干预之后，参与者在识别终点肺炎方面与促进放射科医生的一致性从公平提高到中度（κ=0.34 至 κ=0.49）。
博茨瓦纳的非放射科临床医生并不总是能识别出肺炎的关键胸部 X 光表现。有针对性的培训干预可能会提高非放射科临床医生解读胸部 X 光片的能力。
