Inter-rater agreement in the assessment of abnormal chest X-ray findings for tuberculosis between two Asian countriesTuberculosis and other mycobacterial diseases

• Published in: BMC infectious diseases Vol. 12
• Main Authors: Sakurada, Shinsaku, Hang, Nguyen TL, Ishizuka, Naoki, Toyota, Emiko, Hung, Le D, Chuc, Pham T, Lien, Luu T, Thuong, Pham H, Bich, Pham TN, Keicho, Naoto, Kobayashi, Nobuyuki
• Format: Journal Article
• Language: English
• Published: London BioMed Central 01.01.2012
• Subjects: Agreements; Disease; Hospitals; Payment systems; Reading; Statistical analysis; Studies; Tuberculosis
• ISSN: 1471-2334
• DOI: 10.1186/1471-2334-12-31

Doc number: 31 Abstract Background: Inter-rater agreement in the interpretation of chest X-ray (CXR) films is crucial for clinical and epidemiological studies of tuberculosis. We compared the readings of CXR films used for a survey of tuberculosis between raters from two Asian countries. Methods: Of the 11,624 people enrolled in a prevalence survey in Hanoi, Viet Nam, in 2003, we studied 258 individuals whose CXR films did not exclude the possibility of active tuberculosis. Follow-up films obtained from accessible individuals in 2006 were also analyzed. Two Japanese and two Vietnamese raters read the CXR films based on a coding system proposed by Den Boon et al. and another system newly developed in this study. Inter-rater agreement was evaluated by kappa statistics. Marginal homogeneity was evaluated by the generalized estimating equation (GEE). Results: CXR findings suspected of tuberculosis differed between the four raters. The frequencies of infiltrates and fibrosis/scarring detected on the films significantly differed between the raters from the two countries (P < 0.0001 and P = 0.0082, respectively, by GEE). The definition of findings such as primary cavity, used in the coding systems also affected the degree of agreement. Conclusions: CXR findings were inconsistent between the raters with different backgrounds. High inter-rater agreement is a component necessary for an optimal CXR coding system, particularly in international studies. An analysis of reading results and a thorough discussion to achieve a consensus would be necessary to achieve further consistency and high quality of reading.