title: Interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia.
abstract: OBJECTIVE
  To determine the interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia.
  
  
  METHODS
  A cross-sectional reliability study.
  
  
  METHODS
  Nursing homes and an acute care hospital.
  
  
  METHODS
  Four radiologists reviewed 40 mobile chest radiographs obtained from residents of nursing homes who met a clinical definition of lower respiratory tract infections.
  
  
  METHODS
  Radiologists were asked to interpret radiographs with respect to the film quality; presence, pattern, and extent of an infiltrate; and the presence of a pleural effusion or adenopathy. Interrater reliability was evaluated using the intraclass correlation coefficient derived from a 2-way random effects model.
  
  
  RESULTS
  On average the radiologists reported that 6 of the 40 films were of very good or excellent quality and 16 of the 40 were of fair or poor quality. When the finding of an infiltrate was dichotomized (0 = no; 1 = possible, probable, or definite) all 4 radiologists agreed on 21 of the 37 chest radiographs. The intraclass correlation coefficient for the presence or absence of infiltrates was 0.54 (95% confidence intervals [CI] 0.38 to 0.69). For the 14 radiographs where infiltrates were observed by all radiologists, intraclass correlation coefficients for the presence of pleural effusions was 0.08 (95% CI -0.10 to 0.41), hilar adenopathy 0.54 (95% CI 0.29 to 0.79), and mediastinal adenopathy 0.49 (95% CI 0.21 to 0.76).
  
  
  CONCLUSIONS
  In conclusion, the interrater agreement among radiologists for mobile chest radiographs in establishing the presence or absence of an infiltrate can be judged to be "fair." Treatment decisions need to include clinical findings and should not be made based on radiographic findings alone.
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. loebm@mcmaster.ca
authors.forename: Mark B
authors.initials: MB
authors.lastname: Loeb
authors.forename: Soo B Chan
authors.initials: SB
authors.lastname: Carusone
authors.forename: Tom J
authors.initials: TJ
authors.lastname: Marrie
authors.forename: Kevin
authors.initials: K
authors.lastname: Brazil
authors.forename: Paul
authors.initials: P
authors.lastname: Krueger
authors.forename: Lynne
authors.initials: L
authors.lastname: Lohfeld
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Simor
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Walter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D016022:Case-Control Studies; D002637:Chest Pain / Q000209:etiology; D002983:Clinical Competence / Q000592:standards; D003371:Cough / Q000209:etiology; D003428:Cross Infection / Q000150:complications / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology; D009735:Nursing Homes; D015588:Observer Variation; D009864:Ontario; D010996:Pleural Effusion / Q000150:complications / Q000000981:diagnostic imaging; D011014:Pneumonia / Q000150:complications / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems / Q000592:standards*; D013902:Radiography, Thoracic / Q000592:standards*; D011871:Radiology / Q000193:education / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D013183:Sputum; D013997:Time Factors