title: Utility of Keywords from Chest Radiograph Reports for Pneumonia Surveillance Among Hospitalized Patients with Influenza: The CDC Influenza Hospitalization Surveillance Network, 2008-2009.
abstract: Transcripts from admission chest radiographs could aid in identification of pneumonia cases for public health surveillance. We assessed the reliability of radiographic data abstraction and performance of radiographic key terms to identify pneumonia in patients hospitalized with laboratory-confirmed influenza virus infection.
  
  
  
  We used data on patients hospitalized with laboratory-confirmed influenza virus infection from October 2008 through December 2009 from 10 geographically diverse U.S. study sites participating in the Influenza Hospitalization Surveillance Network (FluSurv-NET). Radiographic key terms (i.e., bronchopneumonia, consolidation, infiltrate, airspace density, and pleural effusion) were abstracted from final impressions of chest radiograph reports. We assessed the reliability of radiographic data abstraction by examining the percent agreement and Cohen's k statistic between clinicians and surveillance staff members. Using a composite reference standard for presence or absence of pneumonia based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and discharge summary data, we calculated sensitivity, specificity, positive predictive value (PPV), and percent agreement for individual and combined radiographic key terms.
  
  
  
  For each radiographic key term, the percent agreement between clinicians and surveillance staff members ranged from 89.4% to 98.6% and Cohen's k ranged from 0.46 (moderate) to 0.84 (almost perfect). The combination of bronchopneumonia or consolidation or infiltrate or airspace density terms had sensitivity of 66.5%, specificity of 89.2%, PPV of 80.4%, and percent agreement of 80.1%. Adding pleural effusion did not result in significant changes in sensitivity, specificity, PPV, or percent agreement.
  
  
  
  Radiographic key terms abstracted by surveillance staff members from final impressions of chest radiograph reports had moderate to almost perfect reliability and could be used to identify pneumonia among patients hospitalized with laboratory-confirmed influenza virus infection. This method can inform pneumonia surveillance and aid in public health response.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Bramley
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Chaves
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA.
authors.forename: Fatimah S
authors.initials: FS
authors.lastname: Dawood
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA.
authors.forename: Saumil
authors.initials: S
authors.lastname: Doshi
authors.affiliation: California Emerging Infections Program, Oakland, CA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Reingold
authors.affiliation: Colorado Department of Public Health and Environment, Denver, CO.
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.affiliation: Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Yousey-Hindes
authors.affiliation: Emory University School of Medicine and Veterans Affairs Medical Center, Atlanta, GA.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.affiliation: Maryland Department of Health and Mental Hygiene, Baltimore, MD.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ryan
authors.affiliation: Minnesota Department of Health, St. Paul, MN.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.affiliation: New Mexico Department of Health, Santa Fe, NM.
authors.forename: Joan
authors.initials: J
authors.lastname: Baumbach
authors.affiliation: New York State Department of Health, Emerging Infections Program, Albany, NY.
authors.forename: Shelley
authors.initials: S
authors.lastname: Zansky
authors.affiliation: University of Rochester School of Medicine and Dentistry, Center for Community Health and Department of Medicine, Rochester, NY.
authors.forename: Nancy
authors.initials: N
authors.lastname: Bennett
authors.affiliation: Oregon Public Health Division, Portland, OR.
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA.
authors.forename: Lyn
authors.initials: L
authors.lastname: Finelli
authors.affiliation: Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Influenza Division, Atlanta, GA.
authors.forename: Seema
authors.initials: S
authors.lastname: Jain
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D006760:Hospitalization; D006801:Humans; D007251:Influenza, Human; D015588:Observer Variation; D011014:Pneumonia / Q000175:diagnosis*; D011159:Population Surveillance / Q000379:methods*; D013902:Radiography, Thoracic; D015203:Reproducibility of Results; D009626:Terminology as Topic; D014481:United States