title: Evaluation of the World Health Organization criteria for chest radiographs for pneumonia diagnosis in children.
abstract: Our objective was to compare the inter-observer level of agreement in diagnosing pneumonia using the World Health Organization (WHO) guidelines for the interpretation of radiographs. We conducted a prospective study in a pediatric emergency room. Fifteen observers (13 pediatricians, 2 radiologists) interpreted 200 pediatric (<5 years old) chest radiographs using the WHO guidelines. Observers were blinded to the clinical presentation. RESULTS were analyzed for kappa values. Individual readings were compared to two "gold standard" teams: (1) radiologist and pediatrician and (2) two radiologists.
  
  
  RESULTS
  Alveolar pneumonia, non-alveolar pneumonia, and no pneumonia were found (by radiologists) in 12.8%, 2.7%, and 78.6% of readings, respectively. The mean kappa values for alveolar pneumonia, non-alveolar pneumonia, and no pneumonia of observers versus the team consisting of a radiologist and a pediatrician were 0.73, 0.23, and 0.61, respectively. For non-alveolar pneumonia, the mean kappa value was higher for the gold standard consisting of a radiologist and a pediatrician when compared to the two-radiologist team. Pediatricians overdiagnosed "non-alveolar pneumonia" compared with radiologists. In contrast, for the alveolar pneumonia and no-pneumonia diagnoses, no significant differences were found.
  
  
  CONCLUSIONS
  The WHO guidelines for interpretation of chest radiographs result in high level of agreement between readers for the definition of "alveolar pneumonia" and "no pneumonia" but poor agreement for non-alveolar pneumonia. The disagreement with regard to the latter was associated with overdiagnosis by pediatricians, which may lead to overtreatment. We believe that radiographic non-alveolar pneumonia should not be an endpoint for clinical trials and research, nor should it be implemented in clinical setting.
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Shalom
authors.initials: S
authors.lastname: Ben Shimol
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
authors.forename: Noga
authors.initials: N
authors.lastname: Givon-Lavi
authors.forename: Asher
authors.initials: A
authors.lastname: Tal
authors.forename: Micha
authors.initials: M
authors.lastname: Aviram
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar-Ziv
authors.forename: Vadim
authors.initials: V
authors.lastname: Zodicov
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
mesh_terms: D002675:Child, Preschool; D003951:Diagnostic Errors; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015588:Observer Variation; D011014:Pneumonia / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011859:Radiography; D016037:Single-Blind Method; D014944:World Health Organization