Effect of Clinical History on the Interpretation of Chest Radiographs in Childhood Bronchiolitis

Abstract

This study assesses the effect of a clinical history of "bronchiolitis" versus "well child" on the interpretation of pediatric chest radiographs. Radiologists reviewed radiographs previously identified as "definite bronchiolitis," "equivocal bronchiolitis," "definite normal," and "equivocal normal." They were asked to identify features of bronchiolitis and give a confidence level for their diagnosis. A correct clinical history of "bronchiolitis" or a "well child" was provided for all definite and half the equivocal radiographs. The other half of the equivocal radiographs were matched with incorrect histories. Given normal radiographs with a history of bronchiolitis, radiologists reported more features of bronchiolitis with increased confidence and also more features. The results suggest that the effect of history is not simply to provide additional confirmatory information, thereby increasing the diagnosis rating, but rather to change the interpretation of features, to the extent that features apparently are seen even on normal radiographs.