INTEROBSERVER VARIATION IN THE CHEST RADIOGRAPH COMPONENT OF THE LUNGINJURY SCORE

The lung injury score is a semi-quantitative system used in the defini tion and grading of the acute respiratory distress syndrome. It is com posed of two, three or four equally weighted components. One component is derived from the chest radiograph, which may contribute up to 50% of the total score. A score of 1 is awarded for each quadrant on the c hest radiograph which contains alveolar consolidation. We examined the interobserver variation between two anaesthetists, two radiologists a nd two critical care physicians who scored blindly 100 chest radiograp hs from patients with adult respiratory distress syndrome. There was v ery good agreement between the two radiologists in the total scores (k appa 0.97) and in individual scores in each of the 4 quadrants (kappa 0.97-1.0). The agreement between anaesthetists and radiologists was on ly fair for the total score (kappa 0.37-0.42), but moderate to good fo r individual quadrant scores (kappa 0.43-0.73). The agreement between the two anaesthetists was moderate for individual quadrant scores (kap pa 0.44-0.60), but only fair for total score (kappa 0.04-0.20). Agreem ent between the physicians and other observers was poor to fair for th e total score (kappa 0.12-0.32) and poor to moderate for the individua l quadrant scores (kappa 0.15-0.63). Both anaesthetists and physician 2 underestimated the overall chest scores (median scores 2, 3 and 1 re spectively) in comparison to the radiologists (median scores 3.5). Phy sician 1 significantly overscored (median score 4). The chest radiogra ph component of the lung injury score can be consistently assessed by radiologists, but significant variations may be introduced when assess ed by other clinicians. This has significant implications for the use of the lung score in studies of adult respiratory distress syndrome an d other studies which incorporate radiographic appearances in the defi nition.