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

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.