title: Impact of clinical history on chest radiograph interpretation.
abstract: BACKGROUND
  The inclusion of clinical information may have unrecognized influence in the interpretation of diagnostic testing.
  
  
  OBJECTIVE
  The objective of the study was to determine the impact of clinical history on chest radiograph interpretation in the diagnosis of pneumonia.
  
  
  METHODS
  Prospective case-based study.
  
  
  METHODS
  Radiologists interpreted 110 radiographs of children evaluated for suspicion of pneumonia. Clinical information was withheld during the first interpretation. After 6 months the radiographs were reviewed with clinical information. Radiologists reported on pneumonia indicators described by the World Health Organization (ie, any infiltrate, alveolar infiltrate, interstitial infiltrate, air bronchograms, hilar adenopathy, pleural effusion).
  
  
  METHODS
  Children's Hospital of Philadelphia and Boston Children's Hospital.
  
  
  METHODS
  Six board-certified radiologists.
  
  
  METHODS
  Inter- and inter-rater reliability were assessed using the kappa statistic.
  
  
  RESULTS
  The addition of clinical history did not have a substantial impact on the inter-rater reliability in the identification of any infiltrate, alveolar infiltrate, interstitial infiltrate, pleural effusion, or hilar adenopathy. Inter-rater reliability in the identification of air bronchograms improved from fair (k = 0.32) to moderate (k = 0.53). Intra-rater reliability for the identification of alveolar infiltrate remained substantial to almost perfect for all 6 raters with and without clinical information. One rater had a decrease in inter-rater reliability from almost perfect (k = 1.0) to fair (k = 0.21) in the identification of interstitial infiltrate with the addition of clinical history.
  
  
  CONCLUSIONS
  Alveolar infiltrate and pleural effusion are findings with high intra- and inter-rater reliability in the diagnosis of bacterial pneumonia. The addition of clinical information did not have a substantial impact on the reliability of these findings.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Test
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Michael
authors.initials: M
authors.lastname: Monuteaux
authors.forename: Lilliam
authors.initials: L
authors.lastname: Ambroggio
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Lee
authors.forename: Richard I
authors.initials: RI
authors.lastname: Markowitz
authors.forename: Sarah
authors.initials: S
authors.lastname: Bixby
authors.forename: Stephanie
authors.initials: S
authors.lastname: Diperna
authors.forename: Sabah
authors.initials: S
authors.lastname: Servaes
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Hellinger
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015588:Observer Variation; D010820:Physicians / Q000592:standards*; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods / Q000592:standards*; D012042:Registries; D015203:Reproducibility of Results; D055815:Young Adult