Carrillo-Rodríguez JG, Mejía-Avila ME, Estrada-Garrido A

Language: Spanish
References: 10
Page: 78-81
PDF size: 37.00 Kb.

ABSTRACT

Objective: To determine the variability in subjective interpretation of posteroanterior chest radiographs from asthmatic patients made by two specialists habituated to treat these patients. In addition, to investigate the concordance between clinical signs suggestive of complication and the interpretation of the radiograph images. Methods: Two specialists accustomed to observe radiological images from asthmatic patients reviewed 150 radiographs from patients attending the emergency room of the Instituto Nacional de Enfermedades Respiratorias (Mexico city). Within- and between-observer concordances were assessed through the kappa test. Results: A poor between-observer concordance (k= 0.02), and a regular within-observer concordance (k= 0.65) were found in the interpretation of the chest radiographs. The first observer described 13 radiographs with data suggestive of complication, but just one patient presented it. The second observer considered 85 radiographs as having images suggestive of complications, when only one patient really presented it. In 14 patients there were clinical findings suggesting “pneumonia”, but radiological images did not show data to confirm the diagnosis. Conclusion: Subjective interpretation of the posteroanterior chest X-rays film in asthma crisis had variability in interpretation, with poor within- and between-observer concordance, making this an unreliable diagnostic test. It is important that objective and measurable criteria be established in order to make a confident interpretation and to avoid underdiagnosis, perform expensive unnecessary studies and inadequate treatments.

REFERENCES

1. Manthous CA. Management of severe exacerbations in asthma. Am J Med 1995; 99: 298-308.

2. Fishman AP. editor. Pulmonary diseases and disorders. 2ª ed. New York: McGraw-Hill; 1988.

3. Murray JF, Nadel JA. Textbook of respiratory medicine. 2ª ed. Philadelphia: Saunders, 1994.

4. Reid MJ. Complicating features of asthma. Pediatr Clin North Am 1992; 39: 1327-1341.

5. Davis AM, Wensley DF, Phelan PD. Spontaneous pneumotorax in pediatric patients. Respir Med 1993; 87: 531-534.

6. Gourdon C, Dietemann A. Recurrent interlobar pneumothorax in asthmatic patient. Eur Respir J 1993; 6: 748-750.

7. Murdoch IA, Huggon IC. Rapid diagnosis of the cause of pneumoperitoneum in ventilated asthmatic children. Acta Pediatr 1993; 82: 108-110.

8. Pickup CM, Nee PA, Randall PE. Radiographic features in 1016 adults admitted to hospital with acute asthma. J Accid Emerg Med 1994; 11: 234-237.

9. Beckert L, Jones D, Picken G. The usefulness of chest radiographs in acute asthma. Am J Respir Crit Care Med 1996; 153: A522.

10. Kardon EM. Acute asthma. Emerg Med Clin North Am 1996; 14: 93-114.