Fh. Bloomfield et al., Inter- and intra-observer variability in the assessment of atelectasis andconsolidation in neonatal chest radiographs, PEDIAT RAD, 29(6), 1999, pp. 459-462
Background. Radiology is an essential part of neonatal intensive care. Inte
rpretation of chest radiographs frequently contributes to respiratory manag
ement of neonates, but there has been little assessment of the consistency
of this interpretation.
Objective. To assess the inter- and intra-observer variability for the repo
rting of atelectasis and/or consolidation in neonatal chest radiographs,
Materials and methods. A total of 585 chest radiographs from the 220 babies
ventilated in our nursery over a 2-year period were coded by two radiologi
sts for generalised, lobar and segmental atelectasis and/or consolidation.
Two months later one of the radiologists re-coded a random sample of these
films (n = 117, 20%). Agreement was assessed by the kappa statistic and by
proportions of agreement for normality and abnormality.
Results. The reported incidence of focal atelectasis was low (5-6%). Focal
changes of any nature were found in 21-26% of films. Inter-observer agreeme
nt was fair to moderate (kappa = 0.25-0.44). Intra-observer agreement was m
ostly moderate to good (kappa = 0.38-0.66).
Conclusion. The poor inter-observer agreement for the diagnosis of pulmonar
y parenchymal abnormalities on chest radiographs of neonates receiving inte
nsive care suggests that abnormalities should be described rather than diag
noses given or that a list of differential diagnoses be offered. When resea
rch involves radiographic interpretation, the potential lack of consistency
in reporting abnormalities must be borne in mind.