title: Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility.
abstract: The chest radiograph (CXR) is considered a key diagnostic tool for pediatric tuberculosis (TB) in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts), a medical officer (M.O), and four clinical officers (C.Os) with basic training in pediatric CXR reading blindly assessed CXRs of infants who were TB suspects in a cohort study. C.Os had access to clinical findings for patient management. Weighted kappa scores summarized interrater agreement on lymphadenopathy and abnormalities consistent with TB. Sensitivity and specificity of raters were determined using microbiologically confirmed TB as the gold standard (n = 8). A total of 691 radiographs were reviewed. Agreement on abnormalities consistent with TB was poor; k = 0.14 (95% CI: 0.10-0.18) and on lymphadenopathy moderate k = 0.26 (95% CI: 0.18-0.36). M.O [75% (95% CI: 34.9%-96.8%)] and C.Os [63% (95% CI: 24.5%-91.5%)] had high sensitivity for culture confirmed TB. TB vaccine trials utilizing expert agreement on CXR as a nonmicrobiologically confirmed endpoint will have reduced specificity and will underestimate vaccine efficacy. C.Os detected many of the bacteriologically confirmed cases; however, this must be interpreted cautiously as they were unblinded to clinical features.
authors.affiliation: Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), Kisumu, Nairobi 40100, Kenya.
authors.forename: G
authors.initials: G
authors.lastname: Kaguthi
authors.affiliation: Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), Kisumu, Nairobi 40100, Kenya ; Academic Medical Centre (AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Nduba
authors.affiliation: Africa Teleradiology, Nairobi 00200, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Nyokabi
authors.affiliation: Kenya Medical Research Institute, Centre for Respiratory Diseases Research (CRDR), Kisumu, Nairobi 40100, Kenya ; School of Public Health, University of Washington, Seattle, WA 98104, USA.
authors.forename: F
authors.initials: F
authors.lastname: Onchiri
authors.affiliation: Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Gie
authors.affiliation: Academic Medical Centre (AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ; Public Health Service of Amsterdam, Department of Infectious Diseases, 1018 WT Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Borgdorff