title: Accuracy of the interpretation of chest radiographs for the diagnosis of paediatric pneumonia.
abstract: BACKGROUND
  World Health Organization (WHO) radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia.
  
  
  METHODS
  An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification.
  
  
  RESULTS
  There was significant disagreement (22%) between the first and second reports (kappa = 0.70, P<0.001), notably in those aged <5 years (26%, kappa = 0.66, P<0.001). The most frequent sources of disagreement were the reporting of patchy and perihilar changes.
  
  
  CONCLUSIONS
  This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children.
authors.affiliation: Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elemraid
authors.affiliation: Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
authors.forename: Michelle
authors.initials: M
authors.lastname: Muller
authors.affiliation: Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
authors.forename: David A
authors.initials: DA
authors.lastname: Spencer
authors.affiliation: Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Rushton
authors.affiliation: Regional Epidemiology Unit, Public Health England North East, Newcastle upon Tyne, United Kingdom.
authors.forename: Russell
authors.initials: R
authors.lastname: Gorton
authors.affiliation: Department of Respiratory Paediatrics, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Biological, Clinical and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Thomas
authors.affiliation: Department of Paediatrics, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Eastham
authors.affiliation: Department of Paediatrics, James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Hampton
authors.affiliation: Department of Paediatric Infectious Disease and Immunology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Gennery
authors.affiliation: Department of Paediatric Infectious Disease, Royal Children's Hospital, Brisbane, Queensland, Australia.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D011014:Pneumonia / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D011446:Prospective Studies; D013902:Radiography, Thoracic; D014944:World Health Organization