• Daniel Brooks, Stephen E Wright, Anna Beattie, Nadia McAllister, Niall H Anderson, Alistair I Roy, Philip Gonsalves, Bryan Yates, Sara Graziadio, Alasdair Mackie, John Davidson, Sandeep Vijaya Gopal, Robert Whittle, Asef Zahed, Lorna Barton, Mathew Elameer, John Tuckett, Rob Holmes, Alexandra Sutcliffe, Nuria Santamaria, Luke la Hausse de Lalouviere, Sanjay Gupta, Jeevan Subramaniam, Janaki A Pearson, Matthew Brandwood, Richard Burnham, Anthony J Rostron, and A John Simpson.
• Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK; Emergency Department, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia.
• J Crit Care. 2024 Aug 1; 82: 154760154760.

PurposeChest radiographs in critically ill patients can be difficult to interpret due to technical and clinical factors. We sought to determine the agreement of chest radiographs and CT scans, and the inter-observer variation of chest radiograph interpretation, in intensive care units (ICUs).MethodsChest radiographs and corresponding thoracic computerised tomography (CT) scans (as reference standard) were collected from 45 ICU patients. All radiographs were analysed by 20 doctors (radiology consultants, radiology trainees, ICU consultants, ICU trainees) from 4 different centres, blinded to CT results. Specificity/sensitivity were determined for pleural effusion, lobar collapse and consolidation/atelectasis. Separately, Fleiss' kappa for multiple raters was used to determine inter-observer variation for chest radiographs.ResultsThe median sensitivity and specificity of chest radiographs for detecting abnormalities seen on CTs scans were 43.2% and 85.9% respectively. Diagnostic sensitivity for pleural effusion was significantly higher among radiology consultants but no specialty/experience distinctions were observed for specificity. Median inter-observer kappa coefficient among assessors was 0.295 ("fair").ConclusionsChest radiographs commonly miss important radiological features in critically ill patients. Inter-observer agreement in chest radiograph interpretation is only "fair". Consultant radiologists are least likely to miss thoracic radiological abnormalities. The consequences of misdiagnosis by chest radiographs remain to be determined.Copyright © 2024. Published by Elsevier Inc.

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