title: Accuracy of portable chest radiography in the critical care setting. Diagnosis of pneumonia based on quantitative cultures obtained from protected brush catheter.
abstract: Sixty-six supine portable chest radiographs done on the day of bronchoscopy in 62 critical care unit patients suspected of having pneumonia were examined in a blinded fashion by two radiologists. Quantitative culture results obtained from protected brush catheter (PBC) specimens were compared with chest radiograph scores. For one observer, the sensitivity of the chest radiograph for predicting the presence of positive culture results was 0.60, specificity was 0.29, overall agreement was 0.41, positive predictive value was 0.34, and negative predictive value was 0.55. For the second observer, the values were as follows: sensitivity, 0.64; specificity, 0.27; overall agreement, 0.41; positive predictive value, 0.35; and negative predictive value, 0.55. The kappa statistic was calculated at 0.27 indicating marginal interobserver reproducibility. We conclude the portable chest radiograph in the critical care setting is not accurate in predicting the presence of pneumonia when the diagnosis is based on quantitative cultures obtained from protected brush catheter specimens.
authors.affiliation: Victoria Hospital Corporation, London, Ontario, Canada.
authors.forename: M S
authors.initials: MS
authors.lastname: Lefcoe
authors.forename: G A
authors.initials: GA
authors.lastname: Fox
authors.forename: D J
authors.initials: DJ
authors.lastname: Leasa
authors.forename: R K
authors.initials: RK
authors.lastname: Sparrow
authors.forename: D G
authors.initials: DG
authors.lastname: McCormack
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003428:Cross Infection / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology*; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000295:instrumentation / Q000592:standards; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000295:instrumentation