Sawyer S M, Carlin J B, DeCampo M, Bowes G
Department of Thoracic Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
Thorax. 1994 Sep;49(9):863-6. doi: 10.1136/thx.49.9.863.
A number of chest radiographic scores have been developed to assess the severity of respiratory disease in cystic fibrosis but critical statistical evaluation has been limited. In particular, the chest radiograph component of the National Institutes of Health (NIH) clinical score has not previously been validated. Three different chest radiograph scores have been compared and the association between them and lung function tests investigated.
The interobserver and intraobserver variation of the Brasfield, NIH chest radiograph, and the Royal Children's Hospital (RCH) chest radiograph score was assessed by three observers--a paediatric radiologist, a junior and a senior respiratory physician--who independently scored, on separate occasions, 62 chest radiographs randomly selected from three age strata of patients ranging from 7 to 18 years. Lung function tests were available for 61 patients obtained within three months of the chest radiograph. Two way analysis of variance was used to estimate components of variation in scores.
Results were similar for the Brasfield and NIH scores, both of which demonstrated greater precision than the RCH score, but the estimated repeatability of the Brasfield and NIH scores can be expected to differ by up to 20% of the maximum score. The reliabilities (intraclass correlation) are all reasonably high at 0.74, 0.73, and 0.61 for the Brasfield, NIH, and RCH scores, respectively. The estimated correlation between radiographic scores and lung function tests, adjusted for attenuation caused by measurement error, showed a similar correlation for all three scoring methods ranging from 0.55 to 0.78. Correlations were slightly greater with FEV1% than FVC%. These correlations are substantial but not high, indicating that a large proportion of the variability in radiographic scores cannot be explained by lung function measurements.
The Brasfield and NIH chest radiograph scores have very similar statistical profiles and can be equally recommended if a chest radiograph score is to be used. The RCH radiographic score appears to be less reliable. The limitations of these scores need to be understood.
已经开发了多种胸部X线评分系统来评估囊性纤维化患者呼吸系统疾病的严重程度，但关键的统计学评估有限。特别是，美国国立卫生研究院（NIH）临床评分中的胸部X线部分此前尚未得到验证。本研究比较了三种不同的胸部X线评分系统，并调查了它们与肺功能测试之间的关联。
由一名儿科放射科医生、一名初级呼吸内科医生和一名高级呼吸内科医生组成的三位观察者评估了布拉斯菲尔德（Brasfield）评分、NIH胸部X线评分和皇家儿童医院（RCH）胸部X线评分的观察者间和观察者内变异。他们在不同时间独立对从7至18岁患者的三个年龄层中随机选取的62张胸部X线片进行评分。61名患者在胸部X线检查后三个月内进行了肺功能测试。采用双向方差分析来估计评分变异的组成部分。
布拉斯菲尔德评分和NIH评分的结果相似，二者均显示出比RCH评分更高的精确性，但布拉斯菲尔德评分和NIH评分的估计重复性预计相差高达最高分的20%。布拉斯菲尔德评分、NIH评分和RCH评分的可靠性（组内相关性）分别为0.74、0.73和0.61，均相当高。经测量误差引起的衰减校正后，影像学评分与肺功能测试之间的估计相关性显示，所有三种评分方法的相关性相似，范围为0.55至0.78。与第一秒用力呼气容积百分比（FEV1%）的相关性略大于用力肺活量（FVC）。这些相关性较强但不高，表明影像学评分中很大一部分变异性无法通过肺功能测量来解释。
布拉斯菲尔德胸部X线评分和NIH胸部X线评分具有非常相似的统计特征，如果要使用胸部X线评分，二者均可同等推荐。RCH影像学评分似乎可靠性较低。需要了解这些评分的局限性。
