Melingui B F, Leroy-Terquem E, Taguebue J V, Eap T C, Borand L, Khosa C, Moh R, Mwanga-Amumpaire J, Beneteau S, Eang M T, Manhiça I, Mustapha A, Marcy O, Wobudeya E, Norval P Y, Bonnet M
Institut de Recherche pour le développement (IRD), University of Montpellier, Montpellier, France.
François Quesnay Hospital, International Pulmonology Support, Mantes-la-Jolie, France.
IJTLD Open. 2024 Oct 1;1(10):449-455. doi: 10.5588/ijtldopen.24.0328. eCollection 2024 Oct.
Chest X-ray (CXR) misinterpretation negatively affects the accuracy of childhood TB diagnosis. External quality assurance (EQA) could strengthen CXR reading skills. We assessed the uptake, performance and challenges of an EQA of CXR interpretation within the childhood TB-Speed decentralisation study in six resource-limited countries.
Every quarter, TB suggestive or unreadable CXRs and 10% of remaining CXRs from children with presumptive TB were selected for blind re-reading by national re-readers. The proportion of CXRs selected for EQA and re-read assessed the uptake. The performance was assessed by the proportion of discordant interpretations and the sensitivity and specificity of clinicians' vs re-readers' interpretations. Challenges were retrieved from country reports.
Of 513 eligible CXRs, 309 (60.8%) were selected for EQA and 278/309 (90.0%) re-read. The proportion of discordant interpretation was between 13/48 (27%) in Sierra Leone and 7/13 (53.8%) in Cote d'Ivoire during the first EQA and decreased after the EQAs periods in 3/5 countries. Clinician sensitivity reached 100% in all countries over EQA. Specificity ranged between 13% in Sierra Leone and 65% in Cambodia (first EQA) and increased in 4/5 countries after the EQA periods. CXR transfer and re-readers' workload were the main challenges.
EQA can enhance CXR interpretation for childhood TB diagnosis, provided operational challenges are overcome.
胸部X光（CXR）解读错误会对儿童结核病诊断的准确性产生负面影响。外部质量保证（EQA）可增强CXR解读技能。我们在六个资源有限的国家开展的儿童结核病快速分散化研究中，评估了CXR解读EQA的采用情况、表现及挑战。
每季度，从疑似结核病儿童的CXR中选取提示结核病或无法解读的CXR以及其余CXR的10%，由国家重新阅片者进行盲法重新阅片。选取用于EQA和重新阅片的CXR比例评估采用情况。通过不一致解读的比例以及临床医生与重新阅片者解读的敏感性和特异性来评估表现。从各国报告中获取挑战因素。
在513份符合条件的CXR中，309份（60.8%）被选取用于EQA，其中278/309份（90.0%）进行了重新阅片。在首次EQA期间，不一致解读的比例在塞拉利昂为13/48（27%），在科特迪瓦为7/13（53.8%），在5个国家中的3个国家，EQA阶段后该比例有所下降。在整个EQA过程中，所有国家临床医生的敏感性均达到100%。特异性在塞拉利昂为13%，在柬埔寨（首次EQA）为65%，在4/5的国家，EQA阶段后有所增加。CXR传输和重新阅片者的工作量是主要挑战。
只要克服操作上的挑战，EQA可提高儿童结核病诊断中CXR解读的水平。
