RESUMO
CONTEXT AND OBJECTIVE: Many children with acute lower respiratory tract infections (ALRI) present to the emergency ward with concurrent wheezing. A chest x-ray is often requested to rule out pneumonia. We assessed inter-observer agreement in interpreting x-rays on such children. DESIGNS AND SETTING: Prospective consecutive case study at Instituto de Salud del Niño, Lima, Peru. METHODS: Chest x-rays were obtained from eligible children younger than two years old with ALRI and concurrent wheezing who were seen in the emergency ward of a nationwide pediatric referral hospital. The x-rays were read independently by three different pediatric residents who were aware only that the children had a respiratory infection. All the children had received inhaled beta-adrenergic agonists before undergoing chest x-rays. Lobar and complicated pneumonia cases were excluded from the study. RESULTS: Two hundred x-rays were read. The overall kappa index was 0.2. The highest individual kappa values for specific x-ray findings ranged from 0.26 to 0.34 for rib horizontalization and from 0.14 to 0.31 for alveolar infiltrate. Inter-observer variation was intermediate for alveolar infiltrate (kappa 0.14 to 0.21) and for air bronchogram (kappa 0.13 to 0.23). Reinforcement of the bronchovascular network (kappa 0.10 to 0.16) and air trapping (kappa 0.05 to 0.20) had the lowest agreement. CONCLUSIONS: There was poor inter-observer agreement for chest x-ray interpretation on children with ALRI and concurrent wheezing seen at the emergency ward. This may preclude reliable diagnosing of pneumonia in settings where residents make management decisions regarding sick children. The effects of training on inter-observer variation need further studies.
Assuntos
Sons Respiratórios/diagnóstico , Infecções Respiratórias/diagnóstico por imagem , Doença Aguda , Bronquiolite/diagnóstico por imagem , Estudos Transversais , Interpretação Estatística de Dados , Serviço Hospitalar de Emergência , Humanos , Lactente , Internato e Residência , Variações Dependentes do Observador , Pediatria , Pneumonia/diagnóstico por imagem , Estudos Prospectivos , Alvéolos Pulmonares/diagnóstico por imagem , Radiografia , Costelas/diagnóstico por imagemRESUMO
CONTEXT AND OBJECTIVE: Many children with acute lower respiratory tract infections (ALRI) present to the emergency ward with concurrent wheezing. A chest x-ray is often requested to rule out pneumonia. We assessed inter-observer agreement in interpreting x-rays on such children. DESIGNS AND SETTING: Prospective consecutive case study at Instituto de Salud del Niño, Lima, Peru. METHODS: Chest x-rays were obtained from eligible children younger than two years old with ALRI and concurrent wheezing who were seen in the emergency ward of a nationwide pediatric referral hospital. The x-rays were read independently by three different pediatric residents who were aware only that the children had a respiratory infection. All the children had received inhaled beta-adrenergic agonists before undergoing chest x-rays. Lobar and complicated pneumonia cases were excluded from the study. RESULTS: Two hundred x-rays were read. The overall kappa index was 0.2. The highest individual kappa values for specific x-ray findings ranged from 0.26 to 0.34 for rib horizontalization and from 0.14 to 0.31 for alveolar infiltrate. Inter-observer variation was intermediate for alveolar infiltrate (kappa 0.14 to 0.21) and for air bronchogram (kappa 0.13 to 0.23). Reinforcement of the bronchovascular network (kappa 0.10 to 0.16) and air trapping (kappa 0.05 to 0.20) had the lowest agreement. CONCLUSIONS: There was poor inter-observer agreement for chest x-ray interpretation on children with ALRI and concurrent wheezing seen at the emergency ward. This may preclude reliable diagnosing of pneumonia in settings where residents make management decisions regarding sick children. The effects of training on inter-observer variation need further studies.
CONTEXTO Y OBJETIVO: Muchos niños con infecciones respiratorias agudas (IRA) bajas que se presentan a las unidades de emergencia tienen sibilancias concurrentes. En tales niños se solicita a menudo una radiografía de tórax para descartar neumonía. Realizamos un estudio para evaluar la variación inter-observador en la interpretación de las radiografías en niños con IRA baja y sibilancias concurrentes. TIPO DE ESTUDIO Y LUGAR: Estudio prospectivo de casos consecutivos realizado en el Instituto de Salud del Niño, Lima, Perú. METODOS: Se leyeron las radiografías de tórax de niños consecutivos elegibles menores de 2 años de edad con IRA baja y sibilancias concurrentes que acudieron a la emergencia de un hospital garbed de referencia en Lima, Perú. Las radiografías fueron leídas independientemente por 3 residentes de pediatría diferentes que habían recibido información clínica limitada sobre la presencia de una infección respiratoria. Todos los niños habían recibido agonistas beta-adrenérgicos inhalados antes de que se les tomara las radiografías de tórax. Las neumonías lobares y complicadas fueron excluídas del studio. RESULTADOS: Se leyeron 200 radiografías de tórax. El índice kappa global fue 0.2. Los valores kappa individuales más altos para hallazgos radiológicos específicos oscilaron entre 0.26 a 0.34 para horizontali zación de costillas y de 0.14 a 0.31 para infiltrado alveolar. La variación inter-observador fue intermedia para infiltrado alveolar (kappa 0.14 a 0.21) y para broncograma aéreo (kappa 0.13 a 0.23). l reforzamiento de la trama broncovascular (kappa 0.10 a 0.16) y el atrapamiento de aire (kappa 0.05 a 0.20) tuvieron la concordancia más baja. CONCLUSIONES: Hubo pobre concordancia inter-observador en la interpretación de las radiografías de tórax en niños con IRA baja y sibilancias concurrentes atendidos en la unidad de emergencia. Esto puede impedir un diagnóstico confiable de neumonía en lugares en los que los residents toman...