Observer variation in detecting lymphadenopathy on chest radiography
Abstract:OBJECTIVE: To assess inter- and intra-observer agreement in the detection of lymphadenopathy on chest radiography in children at risk for tuberculosis.
PATIENTS AND METHODS: Retrospective examination of the antero-posterior and lateral chest radiographs of children aged 1 month to 11 years discharged from the short-stay ward of the Red Cross ChildrenÕs Hospital, Cape Town, with a diagnosis of tuberculosis or pneumonia. Four paediatric pulmonologists viewed the radiographs independently. The main outcome measures were inter- and intra-observer agreement on the presence or absence of lymphadenopathy, reported as present, absent or equivocal, and expressed as weighted kappa statistics.
RESULTS: Weighted kappa for the six pairs of observers ranged from 0.14 (95%CI 0.02–0.30) to 0.52 (95%CI 0.35–0.69). After a 3-month interval, intra-observer agreement ranged from 0.44 (95%CI 0.25–0.62) to 0.71 (95%CI 0.56–0.87). The average weighted kappa for inter-observer agreement was 0.33, and the average intra-observer kappa was 0.55.
CONCLUSIONS: There was ‘fair’ inter- and ‘moderate’ intra-observer agreement among paediatric pulmonologists in detecting lymphadenopathy on chest radiography in children. Caution is necessary when basing clinical decisions on the presence of lymphadenopathy on chest radiography.
Document Type: Regular Paper
Affiliations: School of Child and Adolescent Health, Red Cross ChildrenÕs Hospital and University of Cape Town, Cape Town, South Africa
Publication date: 2002-09-01
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