A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study

BMC Medical Imaging

Research Article

Diane Gross¹  Marc-Alain Widdowson¹  Peter Reed²  Dave Harvey³  R. Joan H. Ingram⁴  David Milne⁵  Lucy Modahl⁵  David Perry⁶  Francessa Wilson⁶  Emma Taylor⁷  Cameron C. Grant⁸  Kathryn Haven⁹  Colin McArthur^1,10  Q. Sue Huang^1,11  Ange Bissielo^1,12  Cameron Bringans^1,13  Simone Freundlich^1,13 

[1] Centers for Disease Control and Prevention (CDC), Atlanta, USA;Children’s Research Centre, Starship Children’s Hospital, Auckland, New Zealand;Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand;Infectious Diseases, Auckland City Hospital, Auckland, New Zealand;Radiology, Auckland City Hospital, Auckland, New Zealand;Radiology, Starship Children’s Hospital, Auckland, New Zealand;Starship Children’s Hospital, Auckland, New Zealand;Starship Children’s Hospital, Auckland, New Zealand;The SHIVERS study, Auckland and Wellington, New Zealand;University of Auckland, Auckland, New Zealand;Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Wellesley Street, 1142, Auckland, New Zealand;The SHIVERS study, Auckland and Wellington, New Zealand;The SHIVERS study, Auckland and Wellington, New Zealand;Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand;The SHIVERS study, Auckland and Wellington, New Zealand;Infectious Diseases, Auckland City Hospital, Auckland, New Zealand;The SHIVERS study, Auckland and Wellington, New Zealand;Institute of Environmental Science and Research, Wellington, New Zealand;University of Auckland, Auckland, New Zealand;

关键词: Influenza;    Humans;    Radiography;    Thoracic;    Respiratory tract infections;    Validation studies;   

DOI  :  10.1186/s12880-015-0103-y

 received in 2015-07-21, accepted in 2015-12-16,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system.MethodsWe completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of ≥ 38 °C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes.Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (κ) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (κ > 0.4–0.6), good (κ > 0.6–0.8) and very good (κ > 0.8–1.0).ResultsAgreement between the two pediatric radiologists was very good (κ = 0.83, 95 % CI 0.65–1.00) and between the two adult radiologists was good (κ = 0.75, 95 % CI 0.57–0. 93).Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:κ = 0.65; pediatric resident:κ = 0.69; physician:κ = 0.68; resident:κ = 0.67; research nurse:κ = 0.49, medical students: κ = 0.53 and κ = 0.56).Agreement between clinicians was good-to-very good (pediatrician vs. physician:κ = 0.85; vs. pediatric resident:κ = 0.81; vs. medicine resident:κ = 0.76; vs. research nurse:κ = 0.75; vs. medical students:κ = 0.63 and 0.66).Following review of discrepant CXR report scores by clinician pairs, κ values for radiologist-clinician agreement ranged from 0.59 to 0.70 and for clinician-clinician agreement from 0.97 to 0.99.ConclusionsThis five-point CXR scoring tool, suitable for use in poorly- and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity. The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.

【 授权许可】

CC BY   
© Taylor et al. 2015