• Mark I Neuman, Edward Y Lee, Sarah Bixby, Stephanie Diperna, Jeffrey Hellinger, Richard Markowitz, Sabah Servaes, Michael C Monuteaux, and Samir S Shah.
• Division of Emergency Medicine, Children's Hospital, Boston, Boston, Massachusetts 02115, USA. Mark.Neuman@childrens.harvard.edu
• J Hosp Med. 2012 Apr 1; 7 (4): 294-8.

BackgroundAlthough chest radiography is commonly used to establish the diagnosis of pneumonia in children, the reliability of radiographic findings among radiologists is not well described.ObjectiveWe sought to evaluate the inter-rater and intra-rater reliability of radiographic features commonly described by radiologists in childhood pneumonia.MethodsProspective case-based study. One hundred and ten radiographs of children evaluated in a pediatric emergency department for suspicion of pneumonia were interpreted by six radiologists at two academic children's hospitals. Radiologists were blinded to the clinical history. Reliability of standardized radiographic features was evaluated using the kappa statistic.ResultsThe radiographic finding of an alveolar infiltrate demonstrated substantial reliability among radiologists (κ = 0.69). The presence of 'any infiltrate' and pleural effusion demonstrated moderate reliability (κ = 0.47 and k=0.45, respectively). Other radiographic features were less reliable: air bronchograms (κ = 0.32), hilar adenopathy (κ = 0.21), and interstitial infiltrate (κ = 0.14). Similarly, the finding of alveolar infiltrate demonstrated substantial intra-rater reliability upon review of ten duplicate radiographs, whereas interstitial infiltrate was less reliable.ConclusionThe radiographic finding of an alveolar infiltrate is very reliable among pediatric radiologists, whereas the finding of an interstitial infiltrate is less reliable.Copyright © 2011 Society of Hospital Medicine.

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