Reliability and validity of the World Health Organization reading standards for paediatric chest radiographs used in the field in an impact study of Pneumococcal Conjugate Vaccine in Kilifi, Kenya

• DOI: 10.1371/journal.pone.0200715
• Publication Date: 2018-07-25T17:38:47Z
• Authors: M. Ominde; J. Sande; M. Ooko; C. Bottomley; R. Benamore; K. Park; J. Ignas; K. Maitland; T. Bwanaali; F. Gleeson; A. Scott
• Keywords: Kappa; Chest radiograph; Lobar pneumonia; Pneumococcal Conjugate Vaccine; Gold standard (test); Cohen's kappa

Radiologically-confirmed pneumonia (RCP) is a specific end-point used in trials of Pneumococcal Conjugate Vaccine (PCV) to estimate vaccine efficacy. However, chest radiograph (CXR) interpretation varies within and between readers. We measured the repeatability reliability paediatric CXR using percent agreement Cohen's Kappa validity field readings against expert review study impact PCV on pneumonia.CXRs were obtained from 2716 children admitted 2006 2014 Kilifi County Hospital, Kilifi, Kenya, with clinically-defined severe or very-severe pneumonia. Five clinicians radiologists attended three-day training course WHO standard. All CXRs read once by two local primary Discordant 13% concordant arbitrated panel three radiologists. To assess repeatability, 5% median random sample was presented twice. Sensitivity specificity readers' interpretations estimated 'gold-standard' arbitrators' results.Of CXRs, 2 uninterpretable 159 evaluated The for RCP 89% 0.68 ranged 84-97% 0.19-0.68, respectively, all pathological findings. Intra-observer similar inter-observer reliability. Sensitivities readers detect 69% 73%; specificities 96% 95%.Intra- agreements radiologically-confirmed are fair good. Reasonable sensitivity high make pneumonia, determined field, suitable measure relative effectiveness.