R Triasih1, C Robertson2, J de Campo3, T Duke4, L Choridah5, S M Graham6. 1. Department of Paediatrics, Faculty of Medicine, Dr Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Victoria, Australia. 2. Department of Respiratory Medicine and University of Melbourne, Victoria, Australia. 3. Department of Radiology and University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia. 4. Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Victoria, Australia. 5. Department of Radiology, Dr Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia. 6. Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Victoria, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France.
Abstract
BACKGROUND: There are no published data on the critical review of chest X-ray (CXR) findings of children in the context of community-based contact screening. OBJECTIVES: To describe the quality, findings and inter-observer agreement of CXRs in child TB contacts in Indonesia. METHODS: We performed antero-posterior (AP) and lateral CXR in children who had had close contact with a pulmonary TB case. The CXRs were interpreted independently by four reviewers. RESULTS: A total of 530 CXRs of 265 children were reviewed. Most (63%) of the children were asymptomatic at the time of CXR. Only 60% of the CXRs were reported as moderate to good quality by all reviewers, and inter-observer agreement on quality was slight to moderate (weighted κ = 0.16-0.35) for AP view. The majority of the CXRs were reported as normal (range 65-77%), with fair to moderate inter-observer agreement (κ = 0.25-0.46). Hilar lymphadenopathy (6-16%) was the most common CXR abnormality reported with poor inter-observer agreement (κ = -0.03 to 0.25). CONCLUSION: The CXRs of child TB contacts investigated in the community were characterised by low quality, low agreement and low yield. Our findings support guidelines that CXR is not routinely indicated in asymptomatic child TB contacts in this setting.
BACKGROUND: There are no published data on the critical review of chest X-ray (CXR) findings of children in the context of community-based contact screening. OBJECTIVES: To describe the quality, findings and inter-observer agreement of CXRs in childTB contacts in Indonesia. METHODS: We performed antero-posterior (AP) and lateral CXR in children who had had close contact with a pulmonary TB case. The CXRs were interpreted independently by four reviewers. RESULTS: A total of 530 CXRs of 265 children were reviewed. Most (63%) of the children were asymptomatic at the time of CXR. Only 60% of the CXRs were reported as moderate to good quality by all reviewers, and inter-observer agreement on quality was slight to moderate (weighted κ = 0.16-0.35) for AP view. The majority of the CXRs were reported as normal (range 65-77%), with fair to moderate inter-observer agreement (κ = 0.25-0.46). Hilar lymphadenopathy (6-16%) was the most common CXR abnormality reported with poor inter-observer agreement (κ = -0.03 to 0.25). CONCLUSION: The CXRs of childTB contacts investigated in the community were characterised by low quality, low agreement and low yield. Our findings support guidelines that CXR is not routinely indicated in asymptomatic childTB contacts in this setting.
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