Pneumonia: radiologists agree poorly about lobar pneumonia and air bronchograms on chest X-ray

Clinical bottom line (level 1b)

  1. Radiologists agreed moderately well about the presence of an infiltrate and pleural effusions on chest X-rays of patients with pneumonia.
  2. Radiologists fail to agree about the presence of lobar (vs diffuse) pneumonia or air bronchograms.
Albaum et al: Chest 1996; 110: 343-350
Expires March 2003

The study

Setting: 4 acute hospitals, USA and Canada

282 patients (aged 18 to 99; mean 54 years, 57% female) with pneumonia (clinical symptoms confirmed on chest X-ray)

Excluded if
  • aged < 18
  • discharged from hospital in previous 10 days
  • HIV positive
  • chronic changes on chest X-ray


    • Chest X-rays were reported by 2 independent staff radiologists
    Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.

    The evidence

    infiltrate present: K: 0.37 (95% CI: 0.22 to 0.52)
    multilobar infilitrate: K: 0.51 (95% CI: 0.28 to 0.62)
    pleural effusion: K 0.46 (95% CI: 0.33 to 0.50)
    lobar pneumonia v. bronchopneumonia: K 0.09 (95% CI: -0.04 to 0.22)
    air bronchogram K: 0.01 (95% CI: -0.12 to 0.14)

    Comments

    1. Disagreement over pattern of infiltrate is of low clinical importance
    2. This study does not indicate the interobserver reliability of CXR reading in those with acute respiratory symptoms

    Citation

    1. Albaum MN, Hill LC, Murphy M, et al: interobserver reliability of the chest radiograph in community-aquired pneumonia. Chest 1996; 110: 343-350
    Search Terms: ?
    Contributor: Chris Ball and Clare Wotton, December 1999
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient pneumonia
    Intervention or Exposure findings on chest X-ray
    Outcome agreement between radiologists