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Interpretation of pediatric chest radiographs by non-radiologist clinicians in Botswana using World Health Organization criteria for endpoint pneumonia

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Abstract

Background

In low- and middle-income countries, chest radiographs are most frequently interpreted by non-radiologist clinicians.

Objective

We examined the reliability of chest radiograph interpretations performed by non-radiologist clinicians in Botswana and conducted an educational intervention aimed at improving chest radiograph interpretation accuracy among non-radiologist clinicians.

Materials and methods

We recruited non-radiologist clinicians at a referral hospital in Gaborone, Botswana, to interpret de-identified chest radiographs for children with clinical pneumonia. We compared their interpretations with those of two board-certified pediatric radiologists in the United States. We evaluated associations between level of medical training and the accuracy of chest radiograph findings between groups, using logistic regression and kappa statistics. We then developed an in-person training intervention led by a pediatric radiologist. We asked participants to interpret 20 radiographs before and immediately after the intervention, and we compared their responses to those of the facilitating radiologist. For both objectives, our primary outcome was the identification of primary endpoint pneumonia, defined by the World Health Organization as presence of endpoint consolidation or endpoint effusion.

Results

Twenty-two clinicians interpreted chest radiographs in the primary objective; there were no significant associations between level of training and correct identification of endpoint pneumonia; concordance between respondents and radiologists was moderate (κ=0.43). After the training intervention, participants improved agreement with the facilitating radiologist for endpoint pneumonia from fair to moderate (κ=0.34 to κ=0.49).

Conclusion

Non-radiologist clinicians in Botswana do not consistently identify key chest radiographic findings of pneumonia. A targeted training intervention might improve non-radiologist clinicians’ ability to interpret chest radiographs.

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Acknowledgments

This work was supported by the Thrasher Research Fund, the Children’s Hospital of Philadelphia, the Pincus Family Foundation, and through core services from the Penn Center for Acquired Immunodeficiency Syndrome (AIDS) Research, a program funded by the National Institutes of Health. Funding for this project was also made possible in part by a Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) grant (to M.S.K.) from the International AIDS Society, supported by ViiV Healthcare. The views expressed in this publication do not necessarily reflect the official policies of the International AIDS Society or ViiV Healthcare. M.S.K. received financial support from the National Institutes of Health through the Duke Center for AIDS Research and a Career Development Award. A.P.S. and T.A.M. received financial support from the National Institutes of Health through the Penn Center for AIDS Research.

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Authors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Oluwatunmise A. Fawole, Andrew P. Steenhoff, Kristen A. Feemster & Tonya Arscott-Mills

  2. Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Oluwatunmise A. Fawole, Andrew P. Steenhoff & Kristen A. Feemster

  3. New York University School of Medicine, New York, NY, USA

    Oluwatunmise A. Fawole

  4. Botswana-UPenn Partnership, University of Botswana Main Campus, P.O. Box AC 157 ACH, Gaborone, Botswana

    Matthew S. Kelly, Andrew P. Steenhoff & Tonya Arscott-Mills

  5. Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Matthew S. Kelly, Andrew P. Steenhoff, Kristen A. Feemster & Tonya Arscott-Mills

  6. Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, NC, USA

    Matthew S. Kelly

  7. Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana

    Andrew P. Steenhoff, Thuso David, Tiny Mazhani & Tonya Arscott-Mills

  8. Department of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Andrew P. Steenhoff, Kristen A. Feemster, Savvas Andronikou & Tonya Arscott-Mills

  9. Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, PA, USA

    Kristen A. Feemster

  10. Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Eric J. Crotty & Mantosh S. Rattan

  11. Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Samir S. Shah

  12. Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Savvas Andronikou

  13. Department of Radiology, University of Cape Town, Cape Town, South Africa

    Savvas Andronikou

Authors
  1. Oluwatunmise A. Fawole
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  2. Matthew S. Kelly
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  6. Mantosh S. Rattan
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Correspondence to Tonya Arscott-Mills.

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Fawole, O.A., Kelly, M.S., Steenhoff, A.P. et al. Interpretation of pediatric chest radiographs by non-radiologist clinicians in Botswana using World Health Organization criteria for endpoint pneumonia. Pediatr Radiol 50, 913–922 (2020). https://doi.org/10.1007/s00247-020-04625-0

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  • DOI: https://doi.org/10.1007/s00247-020-04625-0

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