Inter-rater agreement in the assessment of abnormal chest X-ray findings for tuberculosis between two Asian countries

Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

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Acute Abdominal Pain and an Abnormal Chest X-ray

Hospital Practice ◽

10.1080/21548331.1982.11698057 ◽

1982 ◽

Vol 17 (4) ◽

pp. 65-70

Author(s):

Lawrence Kaplan ◽

Michael Young ◽

Leonard Krilov

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

X Ray ◽

Abnormal Chest ◽

Chest X Ray

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Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

European Journal of Pediatrics ◽

10.1007/s00431-020-03710-8 ◽

2020 ◽

Vol 180 (1) ◽

pp. 137-146

Author(s):

Nora Tusor ◽

Angela De Cunto ◽

Yousef Basma ◽

John L. Klein ◽

Virginie Meau-Petit

Keyword(s):

Lung Disease ◽

Chronic Lung Disease ◽

Lung Ultrasound ◽

Clinical Laboratory ◽

Control Group ◽

Ventilator Associated Pneumonia ◽

Lung Pathology ◽

Rater Agreement ◽

X Ray ◽

Chest X Ray

AbstractNo consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known:• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New:• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.

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The association of abnormal chest X-ray findings with mortality in patients requiring mechanical ventilation in mulago hospital general intensive care unit

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a674 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

HDG Ssemmanda ◽

J Ejoku ◽

TS Luggya ◽

C Lubulwa

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

General Intensive Care Unit ◽

Mulago Hospital ◽

X Ray ◽

Abnormal Chest ◽

Chest X Ray ◽

Hospital General

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Early clinical predictors of severe acute respiratory syndrome in the emergency department

CJEM ◽

10.1017/s148180350000885x ◽

2004 ◽

Vol 6 (01) ◽

pp. 12-21 ◽

Cited By ~ 2

Author(s):

W.N. Wong ◽

Antonio C.H. Sek ◽

Rick F.L. Lau ◽

K.M. Li ◽

Joe K.S. Leung ◽

...

Keyword(s):

Emergency Department ◽

Severe Acute Respiratory Syndrome ◽

Lymphocyte Count ◽

Case Definition ◽

World Health ◽

Clinical Predictors ◽

X Ray ◽

Abnormal Chest ◽

Contact Exposure ◽

Chest X Ray

ABSTRACT Objectives: To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS). Methods: This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described. Results: Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature >38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count <1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS. Conclusions: Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

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‘My Doctor Said I Had an Abnormal Chest X-Ray...’

Respiration ◽

10.1159/000070075 ◽

2003 ◽

Vol 70 (2) ◽

pp. 224-228

Author(s):

Hector E. Mateo ◽

Alpha A. Fowler

Keyword(s):

X Ray ◽

Abnormal Chest ◽

Chest X Ray

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Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2020-000646 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000646 ◽

Cited By ~ 2

Author(s):

Bruce Kirenga ◽

Winters Muttamba ◽

Alex Kayongo ◽

Christopher Nsereko ◽

Trishul Siddharthan ◽

...

Keyword(s):

Statistical Significance ◽

Sub Saharan Africa ◽

Detailed Data ◽

X Ray ◽

Mild Disease ◽

Clinical Recovery ◽

Abnormal Chest ◽

Chest X Ray ◽

Sub Saharan ◽

Muscle Ache

RationaleDetailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited.ObjectiveWe determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda.MeasurementsAs of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation.Main resultsThe median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance.ConclusionMost of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.

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