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Observer variation in chest radiography of acute lower respiratory infections in children: a systematic review.

ABSTRACT: BACKGROUND: Knowledge of the accuracy of chest radiograph findings in acute lower respiratory infection in children is important when making clinical decisions. METHODS: I conducted a systematic review of agreement between and within observers in the detection of radiographic features of acute lower respiratory infections in children, and described the quality of the design and reporting of studies, whether included or excluded from the review.Included studies were those of observer variation in the interpretation of radiographic features of lower respiratory infection in children (neonatal nurseries excluded) in which radiographs were read independently and a clinical population was studied. I searched MEDLINE, HealthSTAR and HSRPROJ databases (1966 to 1999), handsearched the reference lists of identified papers and contacted authors of identified studies. I performed the data extraction alone. RESULTS: Ten studies of observer interpretation of radiographic features of lower respiratory infection in children were identified. Seven of the studies satisfied four or more of the seven design and reporting criteria. Six studies met the inclusion criteria for the review. Inter-observer agreement varied with the radiographic feature examined. Kappa statistics ranged from around 0.80 for individual radiographic features to 0.27-0.38 for bacterial vs viral etiology. CONCLUSIONS: Little information was identified on observer agreement on radiographic features of lower respiratory tract infections in children. Agreement varied with the features assessed from "fair" to "very good". Aspects of the quality of the methods and reporting need attention in future studies, particularly the description of criteria for radiographic features.

SUBMITTER: Swingler GH

PROVIDER: S-EPMC60656 | biostudies-literature | 2001

REPOSITORIES: biostudies-literature

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Observer variation in chest radiography of acute lower respiratory infections in children: a systematic review.

Swingler George H GH

BMC medical imaging 20010101 1

BACKGROUND: Knowledge of the accuracy of chest radiograph findings in acute lower respiratory infection in children is important when making clinical decisions. METHODS: I conducted a systematic review of agreement between and within observers in the detection of radiographic features of acute lower respiratory infections in children, and described the quality of the design and reporting of studies, whether included or excluded from the review.Included studies were those of observer variation in ...[more]

PMID: 11734068

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Project description:BACKGROUND: Measles was responsible for an estimated 100,000 deaths worldwide in 2008. Despite being a vaccine-preventable disease, measles remains a major cause of morbidity and mortality in young children. Although a safe and effective injectable measles vaccine has been available for over 50 years it has not been possible to achieve the uniformly high levels of coverage (required to achieve measles eradication) in most parts of the developing world. Aerosolised measles vaccines are now under development with the hope of challenging the delivery factors currently limiting the coverage of the existing vaccine. METHODS: We used a modified CHNRI methodology for setting priorities in health research investments to assess the strengths and weaknesses of this emerging intervention to decrease the burden of childhood pneumonia. This was done in two stages. In Stage I, we systematically reviewed the literature related to emerging aerosol vaccines against measles relevant to several criteria of interest. Although there are a number of different aerosol vaccine approaches under development, for the purpose of this exercise, all were considered as one intervention. The criteria of interest were: answerability; cost of development, production and implementation; efficacy and effectiveness; deliverability, affordability and sustainability; maximum potential impact on disease burden reduction; acceptability to the end users and health workers; and effect on equity. In Stage II, we conducted an expert opinion exercise by inviting 20 experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies). The policy makers and industry representatives accepted our invitation on the condition of anonymity, due to the sensitive nature of their involvement in such exercises. They answered questions from the CHNRI framework and their "collective optimism" towards each criterion was documented on a scale from 0 to 100%. RESULTS: The panel of experts expressed mixed feelings about an aerosol measles vaccine. The group expressed low levels of optimism regarding the criteria of likelihood of efficacy and low cost of development (scores around 50%); moderate levels of optimism regarding answerability, low cost of production, low cost of implementation and affordability (score around 60%); and high levels of optimism regarding deliverability, impact on equity and acceptability to health workers and end-users (scores over 80%). Finally, the experts felt that this intervention will have a modest but nevertheless important impact on reduction of burden of disease due to childhood pneumonia (median: 5%, interquartile range 1-15%, minimum 0%, maximum 45%). CONCLUSION: Aerosol measles vaccine is at an advanced stage of development, with evidence of good immunogenicity. This new intervention will be presented as a feasible candidate strategy in the campaign for global elimination of measles. It also presents an unique opportunity to decrease the overall burden of disease due to severe pneumonia in young children.

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Observer variation in chest radiography of acute lower respiratory infections in children: a systematic review.

Publications

Observer variation in chest radiography of acute lower respiratory infections in children: a systematic review.

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