Analysis of radiological inter-observeragreement in the diagnosis of pneumonia in children: a challenge in clinical practice

Volume 4, Issue 6, December 2019     |     PP. 239-256      |     PDF (238 K)    |     Pub. Date: December 19, 2019
DOI:    228 Downloads     3750 Views  


Eduardo Jorge da Fonseca Lima, Pediatrician. Postgraduate Coordinator lato sensu of the Instituto de Medicina Integral Prof. Fernando Figueira-IMIP
Maria Anáide Zacchê de Sá Abreu e Lima, Radiology Resident Doctor. Instituto de Medicina Integral Prof. Fernando Figueira-IMIP
Eduardo Just da Costa e Silva, Pediatric Radiologist. Instructor of the Radiology Department of Instituto de Medicina Integral Prof. Fernando Figueira-IMIP

Background:Despite the 2001 standardized interpretation criteria established by the World Health Organization, the radiological identification of pneumonia in childrenremains challenging, with significant inter-observer variability persisting.Objectives: To describe the epidemiological and clinical characteristics of community-acquired pneumonia in children and to evaluate inter-observer radiological agreement in the diagnosis of pneumonia in children under five years of age. Materials andMethods: A descriptive, observational study involving452 patientshospitalized in a pediatric referral centerbetween October 2010 and September 2013. Clinical and sociodemographic variables were evaluated. Two independent radiologists evaluated the images according to the World Health Organization’s standardization of interpretation of chest radiographs for the diagnosis of pneumonia in children, modified to take not only consolidation, alveolar infiltrate and pleural effusion into consideration, but also interstitial infiltrate.Results: Around 70% of the children were under two years of ageand family income was one minimum salary or less in half the households. Pneumonia was classified as severe or very severe in 83.9% and complicated in 22.6%. The deathrate was 1.5%. Inter-observer agreement was almost perfectfor pleural effusion (kappa 0.825). Consolidation was the most common finding (66.8%),with inter-observer agreement considered substantial (kappa 0.696). Conversely, agreement was poor for interstitial or alveolar infiltrate (kappa 0.533). Conclusion: Agreement was high for the radiographicfinding of pleural effusion; however, interstitial and alveolar infiltrates proved difficult to interpret. Consolidation was the most common abnormality in hospitalized children with severe pneumonia.

pneumonia; epidemiology; chest radiography; inter-observer agreement.

Cite this paper
Eduardo Jorge da Fonseca Lima, Maria Anáide Zacchê de Sá Abreu e Lima, Eduardo Just da Costa e Silva, Analysis of radiological inter-observeragreement in the diagnosis of pneumonia in children: a challenge in clinical practice , SCIREA Journal of Clinical Medicine. Volume 4, Issue 6, December 2019 | PP. 239-256.


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