Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Director, Geriatric Hospitalist Service, Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
J Am Coll Radiol. 2022 Oct;19(10):1130-1137. doi: 10.1016/j.jacr.2022.05.020. Epub 2022 Jul 2.
Uncertain language in chest radiograph (CXR) reports for the diagnosis of pneumonia is prevalent. The purpose of this study is to validate an a priori stratification of CXR results for diagnosing pneumonia based on language of certainty.
Retrospective chart review.
CXR reports of 2,411 patient visits ≥ 18 years, admitted to medicine, who received a CXR and noncontrast chest CT within 48 hours of emergency department registration at two large academic hospitals (tertiary and quaternary care) were reviewed.
The CXR and CT report impressions were categorized as negative, uncertain, or positive. Uncertain CXRs were further stratified into four categories based on language modifiers for the degree of pneumonia certainty. Comparison of CXR and CT results were determined using χ test; a P value of less than .0033 was considered significant to account for multiple comparisons.
CXR reports for the diagnosis of pneumonia revealed the following distribution: 61% negative, 32% uncertain, and 7% positive; CT reports were 55% negative, 22% uncertain, and 23% positive for the diagnosis of pneumonia. There were significant differences between CXR categories compared with CT categories for diagnosis of pneumonia (P < .001). Negative CXR results were not significantly different than the uncertain category with the most uncertain language (P = .030) but were significantly different from all other uncertain categories and positive CXR results (each P < .001). Positive CXR results were not significantly different than the least uncertain category (most certain language) (P = .130) but were significantly different from all other categories (each P < .001).
Language used in CXR reports to diagnose pneumonia exists in categories of varying certainty and should be considered when evaluating patients for pneumonia.
胸部 X 光片（CXR）报告中用于诊断肺炎的不确定语言较为常见。本研究的目的是验证基于语言确定性对 CXR 结果进行肺炎诊断的预先分层。
回顾性图表审查。
对在两家大型学术医院（三级和四级保健）急诊登记后 48 小时内接受 CXR 和非对比胸部 CT 的 2411 例≥18 岁患者的 CXR 报告进行了回顾。
CXR 和 CT 报告印象分为阴性、不确定或阳性。不确定的 CXR 根据肺炎确定性的语言修饰符进一步分为四个类别。使用 χ 检验比较 CXR 和 CT 结果；P 值小于 0.0033 被认为具有统计学意义，以考虑多次比较。
用于诊断肺炎的 CXR 报告显示以下分布：61%为阴性，32%为不确定，7%为阳性；CT 报告为 55%为阴性，22%为不确定，23%为阳性，用于诊断肺炎。与 CT 类别相比，CXR 类别在诊断肺炎方面存在显著差异（P < 0.001）。阴性 CXR 结果与最不确定类别（语言最不确定）无显著差异（P = 0.030），但与所有其他不确定类别和阳性 CXR 结果有显著差异（各 P < 0.001）。阳性 CXR 结果与最不确定类别（语言最确定）无显著差异（P = 0.130），但与所有其他类别有显著差异（各 P < 0.001）。
用于诊断肺炎的 CXR 报告中的语言存在不同的确定性类别，在评估肺炎患者时应予以考虑。
