[Evaluation of two standardized methods for chest radiographs interpretation in children with pneumonia]. / Evaluación de dos métodos estandarizados de interpretación de radiografías de tórax en niños con neumonía.

OBJECTIVE: To evaluate the accuracy of World Health Organization (WHO) method of interpreting chest radiographs on identifying young children with bacterial pneumonia, and to compare its accuracy with other method. METHODS: Chest radiographs from children aged under 5 years old hospitalized for pneumonia, with microbiological evidence of bacterial or viral infection, were evaluated by 3 observers blinded to other data (pediatrician [P], pulmonologist [N], radiologist [R]) according to WHO and Khamapirad scores. A WHO score=1 and a Khamapirad score >2 were selected as the thresholds suggesting bacterial pneumonia. The relationship between radiographic scores and etiology was evaluated using chi square. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values for predicting bacterial pneumonia were calculated. Interobserver agreement (P vs. N vs. R) was calculated (kappa). RESULTS: 108 chest radiographs were evaluated (87 viral, 21 bacterial). WHO score= 1 was associated with bacterial pneumonia (p <0.001; OR= 6.4; CI 95%= 1.629.7), achieving a Se= 85%, Sp= 51%, PPV= 30%, NPV= 93%. Khamapirad score >2, evaluated by P, was also associated with bacterial pneumonia (p <0.0008; OR= 6.31; CI 95%= 1.8-24.4), achieving a Se= 80%, Sp= 59%, PPV= 32% NPV= 92%. Interobserver agreement was slightly better using WHO score (P vs. N= 0.82, P vs. R= 0.69, N vs. R= 0.85) than Khamapirad score (P vs. N= 0.48, P vs. R= 0.69, N vs. R= 0.82). CONCLUSIONS: Both methods showed similar accuracy in order to identify bacterial pneumonia. WHO score is simpler than Khamapirad score and showed a better interobserver agreement.

Enseñanza de la investigación con un sistema de tutores durante la residencia de pediatría / Mentors-based teaching research program during pediatric residency

RESUMEN. Desde hace diez años el Hospital de Niños Dr. Pedro de Elizalde desarrolla el “Programa de Enseñanza de la Investigaciónen la Residencia. El Programa es obligatorio paramédicos en formación y pretende iniciarlos en metodología dela investigación y promover su producción científica. Se basaen la enseñanza programada de la materia y la concreción deproyectos de investigación de complejidad creciente con supervisióndirecta de tutores, mediante herramientas fundamentales,como actividades docentes específicas y supervisión constantede los progresos en la producción acordada.En diez años se realizaron 318 trabajos y participaron 100tutores.El carácter obligatorio del Programa no puede sustituir elinterés personal en la investigación, pero incrementa la produccióncientífica, aporta antecedentes curriculares y amplía lacapacitación profesional. Por otro lado, al estar contemplado enla asignación de tareas del residente, no resulta desplazado porla tarea asistencial ni por otras metas académicas.Palabras clave: investigación, residencia médica, educación médica.