medwireNews: Research suggests that there is little agreement between physicians when reading chest X-rays for diagnosing pediatric respiratory diseases such as pneumonia.
The team found that lack of experience was a key feature, and suggest that "there is a need to systematically train physicians in chest radiograph reading."
To test agreement in interpretation of 70 chest radiographs of children with acute respiratory disease admitted to a local emergency department during 2010-2011, Francis Mimouni (The Sackler School of Medicine, Tel Aviv, Israel) and colleagues recruited 10 pediatric residents (two from each year of training), three board-certified pediatricians, three pediatric pulmonary specialists, and one pediatric radiologist.
The participating clinicians were given a short medical and laboratory history for each patient and then asked to examine the corresponding chest X-ray for the presence of 10 features, namely, hyperinflation, alveolar infiltration, pleural effusion, atelectasis, tracheal deviation, widened mediastinum, enlarged heart, hilar enlargement, peribronchial cuffing, and poor technique.
They were also asked to make a diagnosis of pneumonia, bronchiolitis, other diagnosis, normal chest X-ray, or impossible diagnosis (for poor technique) and were asked if the patient should be given an antibiotic.
When compared with the interpretation given by the pediatric radiologist, there was little agreement between the observers.
The best agreement for the radiologic features was for pleural effusion and alveolar infiltration, whereas the worst was for tracheal deviation. Regarding diagnoses, the best agreement was for pneumonia, and the worst for impossible diagnosis.
Level of experience made a notable difference as the pediatricians and pediatric pulmonary specialists had better agreement with the radiologist than the residents.
Using the radiologist diagnosis of pneumonia as a gold standard (20 of 70 children), this diagnosis would have been missed by 31% of residents, 25% of pediatricians, and 22% of pediatric pulmonary specialists. In the 20 patients who were diagnosed with pneumonia by the radiologist, 23% of residents, 25% of pediatricians, and 15% of pulmonary specialists would not have prescribed antibiotics.
"We speculate that more rigorous, systematic training, with intensive and immediate feedback mechanism… might improve individual skills in chest radiograph reading, and decrease medical misjudgments," suggest the authors in Acta Paediatrica.
"In addition… in a world where information technology is improving daily, and where radiographs can be read from a remote location, it might be wise, whenever technically and financially feasible, to make it a routine that pediatric chest radiographs be concurrently interpreted by pediatric radiologists," they conclude.
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