• R M Hopstaken, T Witbraad, J M A van Engelshoven, and G J Dinant.
• Department of General Practice, Care and Public Health Research Institute (Caphri), Maastricht University and University Hospital Maastricht, Maastricht, The Netherlands. rogier.hopstaken@hag.unimaas.nl
• Clin Radiol. 2004 Aug 1;59(8):743-52.

AimTo assess inter-observer variation in the interpretation of chest radiographs of individuals with pneumonia versus those without pneumonia.Materials And MethodsChest radiographs of out-patients with a lower respiratory tract infection (LRTI) were assessed for the presence of infiltrates by radiologists from three local hospitals and were reassessed by one university hospital radiologist. Various measures of inter-observer agreement were calculated.ResultsThe observed proportional agreement was 218 in 243 patients (89.7%). Kappa was 0.53 (moderate agreement) with a 95% confidence interval of 0.37 to 0.69. The observed positive agreement (59%) was much lower than for negative agreement (94%). Kappa was considerably lower, if chronic obstructive pulmonary disease was present (kappa = 0.20) or Streptococcus pneumoniae (kappa = -0.29) was the infective agent.ConclusionThe overall inter-observer agreement adjusted for chance was moderate. Inter-observer agreement in cases with pneumonia was much worse than the agreement in negative (i.e. non-pneumonia) cases. A general practitioner's selection of patients with a higher chance of having pneumonia for chest radiography would thus not improve the observer agreement.Copyright 2004 The Royal College of Radiologists

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