Reading and interpretation of chest X-ray in adults with community-acquired pneumonia.
BACKGROUND
Traditional reading of chest X-rays usually has a low prognostic value and poor agreement.


OBJECTIVE
This study aimed to determine the interobserver and intraobserver agreement using two reading formats in patients with community-acquired pneumonia, and to explore their association with etiology and clinical outcomes.


METHODS
A pulmonologist and a radiologist, who were blind to clinical data, interpreted 211 radiographs using a traditional analysis format (type and location of pulmonary infiltrates and pleural findings), and a quantitative analysis (pulmonary damage categorized from 0 to 10). For both, the interobserver and intraobserver agreement was estimated (Kappa statistic and intraclass correlation coefficient). The latter was assessed in a subsample of 25 radiographs three months after the initial reading. Finally, the observers made a joint reading to explore its prognostic usefulness via multivariate analysis.


RESULTS
Seventy-four chest radiographs were discarded due to poor quality. With the traditional reading, the mean interobserver agreement was moderate (0.43). It was considered good when the presence of pleural effusion, and the location of the infiltrates in the right upper lobe and both lower lobes, were evaluated; moderate for multilobar pneumonia; and poor for the type of infiltrates. The mean intraobserver agreement for each reviewer was 0.71 and 0.5 respectively. The quantitative reading had an agreement between good and excellent (interobserver 0.72, intraobserver 0.85 and 0.61). Radiological findings were neither associated to a specific pathogen nor to mortality.


CONCLUSIONS
In patients with pneumonia, the interpretation of the chest X-ray, especially the smallest of details, depends solely on the reader.
Grupo Investigador de Problemas en Enfermedades Infecciosas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
Diana Carolina
DC
Moncada
Zulma Vanessa
ZV
Rueda
Antonio
A
Macías
Tatiana
T
Suárez
Héctor
H
Ortega
Lázaro Agustín
LA
Vélez
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011014:Pneumonia / Q000000981:diagnostic imaging*; D011859:Radiography; D015203:Reproducibility of Results