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Free Content Observer variation in detecting lymphadenopathy on chest radiography

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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.
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Keywords: lymphadenopathy; lymphatic diseases; observer variation; radiography; tuberculosis

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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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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