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Assessment of the comparative agreement between chest radiographs and CT scans in intensive care units

Lookup NU author(s): Daniel Brooks, Dr Stephen Wright, Dr Nadia Mcallister, Dr Sara Graziadio, Dr John Davidson, Dr Mat Elameer, Dr Anthony Rostron, Professor John SimpsonORCiD


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© 2024Purpose: Chest 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). Methods: Chest 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. Results: The 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”). Conclusions: Chest 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.

Publication metadata

Author(s): Brooks D, Wright SE, Beattie A, McAllister N, Anderson NH, Roy AI, Gonsalves P, Yates B, Graziadio S, Mackie A, Davidson J, Gopal SV, Whittle R, Zahed A, Barton L, Elameer M, Tuckett J, Holmes R, Sutcliffe A, Santamaria N, de Lalouviere LLH, Gupta S, Subramaniam J, Pearson JA, Brandwood M, Burnham R, Rostron AJ, Simpson AJ

Publication type: Article

Publication status: Published

Journal: Journal of Critical Care

Year: 2024

Volume: 82

Print publication date: 01/08/2024

Online publication date: 15/03/2024

Acceptance date: 02/04/2018

ISSN (print): 0883-9441

ISSN (electronic): 1557-8615

Publisher: Elsevier


DOI: 10.1016/j.jcrc.2024.154760


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