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Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility

The chest radiograph (CXR) is considered a key diagnostic tool for pediatric tuberculosis (TB) in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts), a...

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Autores principales: Kaguthi, G., Nduba, V., Nyokabi, J., Onchiri, F., Gie, R., Borgdorff, M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150539/
https://www.ncbi.nlm.nih.gov/pubmed/25197271
http://dx.doi.org/10.1155/2014/291841
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author Kaguthi, G.
Nduba, V.
Nyokabi, J.
Onchiri, F.
Gie, R.
Borgdorff, M.
author_facet Kaguthi, G.
Nduba, V.
Nyokabi, J.
Onchiri, F.
Gie, R.
Borgdorff, M.
author_sort Kaguthi, G.
collection PubMed
description The chest radiograph (CXR) is considered a key diagnostic tool for pediatric tuberculosis (TB) in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts), a medical officer (M.O), and four clinical officers (C.Os) with basic training in pediatric CXR reading blindly assessed CXRs of infants who were TB suspects in a cohort study. C.Os had access to clinical findings for patient management. Weighted kappa scores summarized interrater agreement on lymphadenopathy and abnormalities consistent with TB. Sensitivity and specificity of raters were determined using microbiologically confirmed TB as the gold standard (n = 8). A total of 691 radiographs were reviewed. Agreement on abnormalities consistent with TB was poor; k = 0.14 (95% CI: 0.10–0.18) and on lymphadenopathy moderate k = 0.26 (95% CI: 0.18–0.36). M.O [75% (95% CI: 34.9%–96.8%)] and C.Os [63% (95% CI: 24.5%–91.5%)] had high sensitivity for culture confirmed TB. TB vaccine trials utilizing expert agreement on CXR as a nonmicrobiologically confirmed endpoint will have reduced specificity and will underestimate vaccine efficacy. C.Os detected many of the bacteriologically confirmed cases; however, this must be interpreted cautiously as they were unblinded to clinical features.
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spelling pubmed-41505392014-09-07 Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility Kaguthi, G. Nduba, V. Nyokabi, J. Onchiri, F. Gie, R. Borgdorff, M. Interdiscip Perspect Infect Dis Research Article The chest radiograph (CXR) is considered a key diagnostic tool for pediatric tuberculosis (TB) in clinical management and endpoint determination in TB vaccine trials. We set out to compare interrater agreement for TB diagnosis in western Kenya. A pediatric pulmonologist and radiologist (experts), a medical officer (M.O), and four clinical officers (C.Os) with basic training in pediatric CXR reading blindly assessed CXRs of infants who were TB suspects in a cohort study. C.Os had access to clinical findings for patient management. Weighted kappa scores summarized interrater agreement on lymphadenopathy and abnormalities consistent with TB. Sensitivity and specificity of raters were determined using microbiologically confirmed TB as the gold standard (n = 8). A total of 691 radiographs were reviewed. Agreement on abnormalities consistent with TB was poor; k = 0.14 (95% CI: 0.10–0.18) and on lymphadenopathy moderate k = 0.26 (95% CI: 0.18–0.36). M.O [75% (95% CI: 34.9%–96.8%)] and C.Os [63% (95% CI: 24.5%–91.5%)] had high sensitivity for culture confirmed TB. TB vaccine trials utilizing expert agreement on CXR as a nonmicrobiologically confirmed endpoint will have reduced specificity and will underestimate vaccine efficacy. C.Os detected many of the bacteriologically confirmed cases; however, this must be interpreted cautiously as they were unblinded to clinical features. Hindawi Publishing Corporation 2014 2014-08-17 /pmc/articles/PMC4150539/ /pubmed/25197271 http://dx.doi.org/10.1155/2014/291841 Text en Copyright © 2014 G. Kaguthi et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Kaguthi, G.
Nduba, V.
Nyokabi, J.
Onchiri, F.
Gie, R.
Borgdorff, M.
Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility
title Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility
title_full Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility
title_fullStr Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility
title_full_unstemmed Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility
title_short Chest Radiographs for Pediatric TB Diagnosis: Interrater Agreement and Utility
title_sort chest radiographs for pediatric tb diagnosis: interrater agreement and utility
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150539/
https://www.ncbi.nlm.nih.gov/pubmed/25197271
http://dx.doi.org/10.1155/2014/291841
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