Interobserver Reliability of Radiologists’ Interpretations of Mobile Chest Radiographs for Nursing Home–Acquired Pneumonia

Loeb, Mark B.; Carusone, Soo B. Chan; Marrie, Tom J.; Brazil, Kevin; Krueger, Paul; Lohfeld, Lynne; Simor, Andrew E.; Walter, Stephen D.

doi:10.1016/j.jamda.2006.02.004

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Volume 7, Issue 7 , Pages 416-419, September 2006

Interobserver Reliability of Radiologists’ Interpretations of Mobile Chest Radiographs for Nursing Home–Acquired Pneumonia

Mark B. Loeb, MD, MSc
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Address correspondence to: Mark Loeb, MD, MSc, McMaster University, MDCL 3200, 1200 Main Street W., Hamilton, ON, L8N 3Z5 Canada.
Soo B. Chan Carusone, MSc
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
Tom J. Marrie, MD
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
Kevin Brazil, PhD
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- St Joseph’s Health System Research Network, Hamilton, Ontario, Canada
Paul Krueger, PhD
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- St Joseph’s Health System Research Network, Hamilton, Ontario, Canada
Lynne Lohfeld, PhD
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Program for Educational Research and Development, McMaster University, Hamilton, Ontario, Canada
Andrew E. Simor, MD
- Department of Microbiology, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada
Stephen D. Walter, PhD
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

published online 28 May 2006.

Objectives

To determine the interobserver reliability of radiologists’ interpretations of mobile chest radiographs for nursing home–acquired pneumonia.

Design

A cross-sectional reliability study.

Setting

Nursing homes and an acute care hospital.

Participants

Four radiologists reviewed 40 mobile chest radiographs obtained from residents of nursing homes who met a clinical definition of lower respiratory tract infections.

Measurements

Radiologists were asked to interpret radiographs with respect to the film quality; presence, pattern, and extent of an infiltrate; and the presence of a pleural effusion or adenopathy. Interrater reliability was evaluated using the intraclass correlation coefficient derived from a 2-way random effects model.

Results

On average the radiologists reported that 6 of the 40 films were of very good or excellent quality and 16 of the 40 were of fair or poor quality. When the finding of an infiltrate was dichotomized (0 = no; 1 = possible, probable, or definite) all 4 radiologists agreed on 21 of the 37 chest radiographs. The intraclass correlation coefficient for the presence or absence of infiltrates was 0.54 (95% confidence intervals [CI] 0.38 to 0.69). For the 14 radiographs where infiltrates were observed by all radiologists, intraclass correlation coefficients for the presence of pleural effusions was 0.08 (95% CI –0.10 to 0.41), hilar adenopathy 0.54 (95% CI 0.29 to 0.79), and mediastinal adenopathy 0.49 (95% CI 0.21 to 0.76).

Conclusion

In conclusion, the interrater agreement among radiologists for mobile chest radiographs in establishing the presence or absence of an infiltrate can be judged to be “fair.” Treatment decisions need to include clinical findings and should not be made based on radiographic findings alone.

Keywords: Reliability , mobile x-rays , pneumonia , nursing home