Abstract
Background.Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials.Methods.The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1–59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion.Results.A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (κ = 0.50) and between arbitrators was 84% (κ = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (κ = 0.25) and 48.5% (κ = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively).Conclusions.Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process.
Highlights
Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia
The World Health Organization (WHO) methodology for the interpretation of pediatric chest radiograph (CXR) has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials
We describe the process for CXR interpretation in a large childhood pneumonia study, evaluate the standardization of readers and observer variability, and assess the process of arbitration for discordant interpretations
Summary
The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1–59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Pneumonia Etiology Research for Child Health (PERCH) is a multicountry, standardized, case-control study of the causes and risk factors of childhood pneumonia [18]. A total of 4232 cases of hospitalized, WHO-defined severe or very severe pneumonia in children aged 1–59 months were enrolled from August 2011 to January 2014. Most sites used digital CXR imaging equipment, except Zambia and Matlab where analog techniques were used. At Nakhon Phanom and South Africa, analog CXRs were performed for 11 and 8 months, respectively, before digital systems were installed. All sites were assessed as meeting quality and safety requirements prior to study enrollment
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