Voigt Gesche M, Thiele Dominik, Wetzke Martin, Weidemann Jürgen, Parpatt Patricia-Maria, Welte Tobias, Seidenberg Jürgen, Vogelberg Christian, Koster Holger, Rohde Gernot G U, Härtel Christoph, Hansen Gesine, Kopp Matthias V
Department of Pediatric Pneumology and Allergology, University Hospital Schleswig-Holstein, Lübeck, Germany.
Airway Research Center North (ARCN) Lübeck and Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Hannover, Member of the German Center for Lung Research (DZL), Germany.
Pediatr Pulmonol. 2021 Aug;56(8):2676-2685. doi: 10.1002/ppul.25528. Epub 2021 Jun 29.
Although chest radiograph (CXR) is commonly used in diagnosing pediatric community acquired pneumonia (pCAP), limited data on interobserver agreement among radiologists exist. PedCAPNETZ is a prospective, observational, and multicenter study on pCAP. N = 233 CXR from patients with clinical diagnosis of pCAP were retrieved and n = 12 CXR without pathological findings were added. All CXR were interpreted by a radiologist at the site of recruitment and by two external, blinded pediatric radiologists. To evaluate interobserver agreement, the reporting of presence or absence of pCAP in CXR was analyzed, and prevalence and bias-adjusted kappa (PABAK) statistical testing was applied. Overall, n = 190 (82%) of CXR were confirmed as pCAP by two external pediatric radiologists. Compared with patients with pCAP negative CXR, patients with CXR-confirmed pCAP displayed higher C-reactive protein levels and a longer duration of symptoms before enrollment (p < .007). Further parameters, that is, age, respiratory rate, and oxygen saturation showed no significant difference. The interobserver agreement between the onsite radiologists and each of the two independent pediatric radiologists for the presence of pCAP was poor to fair (69%; PABAK = 0.39% and 76%; PABAK = 0.53, respectively). The concordance between the external radiologists was fair (81%; PABAK = 0.62). With regard to typical CXR findings for pCAP, chance corrected interrater agreement was highest for pleural effusions, infiltrates, and consolidations and lowest for interstitial patterns and peribronchial thickening. Our data show a poor interobserver agreement in the CXR-based diagnosis of pCAP and emphasized the need for harmonized interpretation standards.
尽管胸部X光片（CXR）常用于诊断儿童社区获得性肺炎（pCAP），但关于放射科医生之间的观察者间一致性的数据有限。PedCAPNETZ是一项关于pCAP的前瞻性、观察性多中心研究。从临床诊断为pCAP的患者中检索到233份CXR，并添加了12份无病理结果的CXR。所有CXR均由招募地点的一名放射科医生以及两名外部不知情的儿科放射科医生进行解读。为评估观察者间的一致性，分析了CXR中pCAP存在与否的报告，并应用了患病率和偏差调整kappa（PABAK）统计检验。总体而言，两名外部儿科放射科医生确认190份（82%）CXR为pCAP。与CXR显示pCAP阴性的患者相比，CXR确诊为pCAP的患者C反应蛋白水平更高，入院前症状持续时间更长（p < 0.007）。其他参数，即年龄、呼吸频率和血氧饱和度无显著差异。现场放射科医生与两名独立儿科放射科医生中每一位对于pCAP存在情况的观察者间一致性较差至一般（分别为69%；PABAK = 0.39%和76%；PABAK = 0.53）。外部放射科医生之间的一致性一般（81%；PABAK = 0.62）。关于pCAP典型的CXR表现，观察者间一致性经机遇校正后，胸腔积液、浸润和实变最高，而间质改变和支气管周围增厚最低。我们的数据显示，基于CXR诊断pCAP时观察者间一致性较差，并强调了统一解读标准的必要性。
