Interobserver Variability in Applying a Radiographic Definition for ARDS
Acute lung injury (ALI) and ARDS are currently defined by the American-European Consensus Conference (AECC) definition criteria, which contain a radiographic criterion. The accuracy or reliability of this consensus radiographic definition has not been evaluated, and no radiographic definition of ALI...
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| Veröffentlicht in: | Chest 1999-11, Vol.116 (5), p.1347-1353 |
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| creator | Rubenfeld, Gordon D. Caldwell, Ellen Granton, John Hudson, Leonard D. Matthay, Michael A. |
| description | Acute lung injury (ALI) and ARDS are currently defined by the American-European Consensus Conference (AECC) definition criteria, which contain a radiographic criterion. The accuracy or reliability of this consensus radiographic definition has not been evaluated, and no radiographic definition of ALI-ARDS has been evaluated by a large international group of experts.
To study the interobserver variability in applying the AECC radiographic criterion for ALI-ARDS.
Survey.
A convenience sample of 21 experts selected from participants attending the 1997 Toronto Mechanical Ventilation Workshop and from members of the National Institutes of Health ARDS Network.
Participants reviewed 28 randomly selected chest radiograph from critically ill, hypoxemic (Pao2/fraction of inspired oxygen ratio,< 300) patients and decided whether the radiograph fulfilled the AECC definition for ALI-ARDS.
Interobserver agreement in applying the AECC definition for ALI-ARDS was moderate (κ = 0.55; 95% confidence interval, 0.52 to 0.57). Thirteen radiographs (43%) showed nearly complete agreement (defined as 20 or 21 readers in agreement). Nine radiographs (32%) had more than or equal to five dissenting readers. The percentage of radiographs interpreted as consistent with ALI-ARDS by individual readers ranged from 36 to 71%. Participants commented that mild infiltrates, pleural effusions, atelectasis, isolated lower lobe involvement, radiographic technique, and overlying monitoring equipment posed the most difficulties.
The radiographic criterion used in the current AECC definition for ALI-ARDS showed high interobserver variability when applied by expert investigators in the fields of mechanical ventilation and ARDS. This variability may result in differences in ALI-ARDS populations at different clinical research centers and may make it difficult for clinicians to apply the results of clinical trials to their patients. Modifications to the radiographic criterion or annotated reference radiograph may improve the reliability of future definitions for ALI-ARDS. |
| doi_str_mv | 10.1378/chest.116.5.1347 |
| format | Article |
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To study the interobserver variability in applying the AECC radiographic criterion for ALI-ARDS.
Survey.
A convenience sample of 21 experts selected from participants attending the 1997 Toronto Mechanical Ventilation Workshop and from members of the National Institutes of Health ARDS Network.
Participants reviewed 28 randomly selected chest radiograph from critically ill, hypoxemic (Pao2/fraction of inspired oxygen ratio,< 300) patients and decided whether the radiograph fulfilled the AECC definition for ALI-ARDS.
Interobserver agreement in applying the AECC definition for ALI-ARDS was moderate (κ = 0.55; 95% confidence interval, 0.52 to 0.57). Thirteen radiographs (43%) showed nearly complete agreement (defined as 20 or 21 readers in agreement). Nine radiographs (32%) had more than or equal to five dissenting readers. The percentage of radiographs interpreted as consistent with ALI-ARDS by individual readers ranged from 36 to 71%. Participants commented that mild infiltrates, pleural effusions, atelectasis, isolated lower lobe involvement, radiographic technique, and overlying monitoring equipment posed the most difficulties.
The radiographic criterion used in the current AECC definition for ALI-ARDS showed high interobserver variability when applied by expert investigators in the fields of mechanical ventilation and ARDS. This variability may result in differences in ALI-ARDS populations at different clinical research centers and may make it difficult for clinicians to apply the results of clinical trials to their patients. Modifications to the radiographic criterion or annotated reference radiograph may improve the reliability of future definitions for ALI-ARDS.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.116.5.1347</identifier><identifier>PMID: 10559098</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Adolescent ; Adult ; ARDS ; Biological and medical sciences ; chest radiography ; Child ; Child, Preschool ; Humans ; interobserver variability ; Intubation, Intratracheal ; Investigative techniques, diagnostic techniques (general aspects) ; lung injury ; Medical sciences ; Observer Variation ; Prospective Studies ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Radiography, Thoracic ; Reproducibility of Results ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult - diagnostic imaging ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory system ; Surveys and Questionnaires</subject><ispartof>Chest, 1999-11, Vol.116 (5), p.1347-1353</ispartof><rights>1999 The American College of Chest Physicians</rights><rights>1999 INIST-CNRS</rights><rights>Copyright American College of Chest Physicians Nov 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c509t-6b834c7ebfcaca201d4f11e9eb53f071155391ecdddcde62f1df416cbaad0ba03</citedby><cites>FETCH-LOGICAL-c509t-6b834c7ebfcaca201d4f11e9eb53f071155391ecdddcde62f1df416cbaad0ba03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1999189$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10559098$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rubenfeld, Gordon D.</creatorcontrib><creatorcontrib>Caldwell, Ellen</creatorcontrib><creatorcontrib>Granton, John</creatorcontrib><creatorcontrib>Hudson, Leonard D.</creatorcontrib><creatorcontrib>Matthay, Michael A.</creatorcontrib><title>Interobserver Variability in Applying a Radiographic Definition for ARDS</title><title>Chest</title><addtitle>Chest</addtitle><description>Acute lung injury (ALI) and ARDS are currently defined by the American-European Consensus Conference (AECC) definition criteria, which contain a radiographic criterion. The accuracy or reliability of this consensus radiographic definition has not been evaluated, and no radiographic definition of ALI-ARDS has been evaluated by a large international group of experts.
To study the interobserver variability in applying the AECC radiographic criterion for ALI-ARDS.
Survey.
A convenience sample of 21 experts selected from participants attending the 1997 Toronto Mechanical Ventilation Workshop and from members of the National Institutes of Health ARDS Network.
Participants reviewed 28 randomly selected chest radiograph from critically ill, hypoxemic (Pao2/fraction of inspired oxygen ratio,< 300) patients and decided whether the radiograph fulfilled the AECC definition for ALI-ARDS.
Interobserver agreement in applying the AECC definition for ALI-ARDS was moderate (κ = 0.55; 95% confidence interval, 0.52 to 0.57). Thirteen radiographs (43%) showed nearly complete agreement (defined as 20 or 21 readers in agreement). Nine radiographs (32%) had more than or equal to five dissenting readers. The percentage of radiographs interpreted as consistent with ALI-ARDS by individual readers ranged from 36 to 71%. Participants commented that mild infiltrates, pleural effusions, atelectasis, isolated lower lobe involvement, radiographic technique, and overlying monitoring equipment posed the most difficulties.
The radiographic criterion used in the current AECC definition for ALI-ARDS showed high interobserver variability when applied by expert investigators in the fields of mechanical ventilation and ARDS. This variability may result in differences in ALI-ARDS populations at different clinical research centers and may make it difficult for clinicians to apply the results of clinical trials to their patients. Modifications to the radiographic criterion or annotated reference radiograph may improve the reliability of future definitions for ALI-ARDS.</description><subject>Adolescent</subject><subject>Adult</subject><subject>ARDS</subject><subject>Biological and medical sciences</subject><subject>chest radiography</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Humans</subject><subject>interobserver variability</subject><subject>Intubation, Intratracheal</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>lung injury</subject><subject>Medical sciences</subject><subject>Observer Variation</subject><subject>Prospective Studies</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Radiography, Thoracic</subject><subject>Reproducibility of Results</subject><subject>Respiration, Artificial</subject><subject>Respiratory Distress Syndrome, Adult - diagnostic imaging</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Respiratory system</subject><subject>Surveys and Questionnaires</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kM1r3DAQxUVpabZp7z0VU0pu3mosy7Z6W5K0CQQK6cdVyNJoV8EruZI3Zf_7aOuFpIWexIj33rz5EfIW6BJY233UG0zTEqBZ8vxRt8_IAgSDkvGaPScLSqEqWSOqE_IqpTuaZxDNS3IClHNBRbcgV9d-whj6hPEeY_FTRad6N7hpXzhfrMZx2Du_LlRxq4wL66jGjdPFBVrn3eSCL2yIxer24ttr8sKqIeGb43tKfny-_H5-Vd58_XJ9vropNadiKpu-Y7VusbdaaVVRMLUFQIE9Z5a2AJwzAaiNMdpgU1kwtoZG90oZ2ivKTsnZnDvG8GuXz5dblzQOg_IYdknma9tGiCoL3_8jvAu76HM3WVHKgfHukEZnkY4hpYhWjtFtVdxLoPKAWP5BLDNiyeUBcba8O-bu-i2aJ4aZaRZ8OApU0mqwUXnt0qNOCAGdeFy9cevNbxdRpq0ahpzK5qXHun-t_jRbMAO-dxhl0g69RpPtepImuP_3fgB3Hqpe</recordid><startdate>19991101</startdate><enddate>19991101</enddate><creator>Rubenfeld, Gordon D.</creator><creator>Caldwell, Ellen</creator><creator>Granton, John</creator><creator>Hudson, Leonard D.</creator><creator>Matthay, Michael A.</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>19991101</creationdate><title>Interobserver Variability in Applying a Radiographic Definition for ARDS</title><author>Rubenfeld, Gordon D. ; Caldwell, Ellen ; Granton, John ; Hudson, Leonard D. ; Matthay, Michael A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c509t-6b834c7ebfcaca201d4f11e9eb53f071155391ecdddcde62f1df416cbaad0ba03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>ARDS</topic><topic>Biological and medical sciences</topic><topic>chest radiography</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Humans</topic><topic>interobserver variability</topic><topic>Intubation, Intratracheal</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>lung injury</topic><topic>Medical sciences</topic><topic>Observer Variation</topic><topic>Prospective Studies</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Radiography, Thoracic</topic><topic>Reproducibility of Results</topic><topic>Respiration, Artificial</topic><topic>Respiratory Distress Syndrome, Adult - diagnostic imaging</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory system</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rubenfeld, Gordon D.</creatorcontrib><creatorcontrib>Caldwell, Ellen</creatorcontrib><creatorcontrib>Granton, John</creatorcontrib><creatorcontrib>Hudson, Leonard D.</creatorcontrib><creatorcontrib>Matthay, Michael A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rubenfeld, Gordon D.</au><au>Caldwell, Ellen</au><au>Granton, John</au><au>Hudson, Leonard D.</au><au>Matthay, Michael A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interobserver Variability in Applying a Radiographic Definition for ARDS</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1999-11-01</date><risdate>1999</risdate><volume>116</volume><issue>5</issue><spage>1347</spage><epage>1353</epage><pages>1347-1353</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>Acute lung injury (ALI) and ARDS are currently defined by the American-European Consensus Conference (AECC) definition criteria, which contain a radiographic criterion. The accuracy or reliability of this consensus radiographic definition has not been evaluated, and no radiographic definition of ALI-ARDS has been evaluated by a large international group of experts.
To study the interobserver variability in applying the AECC radiographic criterion for ALI-ARDS.
Survey.
A convenience sample of 21 experts selected from participants attending the 1997 Toronto Mechanical Ventilation Workshop and from members of the National Institutes of Health ARDS Network.
Participants reviewed 28 randomly selected chest radiograph from critically ill, hypoxemic (Pao2/fraction of inspired oxygen ratio,< 300) patients and decided whether the radiograph fulfilled the AECC definition for ALI-ARDS.
Interobserver agreement in applying the AECC definition for ALI-ARDS was moderate (κ = 0.55; 95% confidence interval, 0.52 to 0.57). Thirteen radiographs (43%) showed nearly complete agreement (defined as 20 or 21 readers in agreement). Nine radiographs (32%) had more than or equal to five dissenting readers. The percentage of radiographs interpreted as consistent with ALI-ARDS by individual readers ranged from 36 to 71%. Participants commented that mild infiltrates, pleural effusions, atelectasis, isolated lower lobe involvement, radiographic technique, and overlying monitoring equipment posed the most difficulties.
The radiographic criterion used in the current AECC definition for ALI-ARDS showed high interobserver variability when applied by expert investigators in the fields of mechanical ventilation and ARDS. This variability may result in differences in ALI-ARDS populations at different clinical research centers and may make it difficult for clinicians to apply the results of clinical trials to their patients. Modifications to the radiographic criterion or annotated reference radiograph may improve the reliability of future definitions for ALI-ARDS.</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>10559098</pmid><doi>10.1378/chest.116.5.1347</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult ARDS Biological and medical sciences chest radiography Child Child, Preschool Humans interobserver variability Intubation, Intratracheal Investigative techniques, diagnostic techniques (general aspects) lung injury Medical sciences Observer Variation Prospective Studies Radiodiagnosis. Nmr imagery. Nmr spectrometry Radiography, Thoracic Reproducibility of Results Respiration, Artificial Respiratory Distress Syndrome, Adult - diagnostic imaging Respiratory Distress Syndrome, Adult - therapy Respiratory system Surveys and Questionnaires |
| title | Interobserver Variability in Applying a Radiographic Definition for ARDS |
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