Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study
机构：[1]Medical ICU, Peking Union Medical College Hospital, 1 Shuai Fu Yuan,Beijing 100730, People’s Republic of China[2]Department of EmergencyMedicine, The First Affiliated Hospital of Kunming Medical University, 295 Xichang Street, Kunming 650032, People’s Republic of China内科科室急诊医学科昆明医科大学附属第一医院[3]Department ofCritical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, 1Liyushan Road, Urumqi 830054, People’s Republic of China[4]Department ofCritical Care Medicine, The First Affiliated Hospital, Harbin Medical University,23 Youzheng Street, Harbin 150001, People’s Republic of China[5]Departmentof Critical Care Medicine, Tongji Hospital, Tongji Medical College, HuazhongUniversity of Science & Technology, 1095 Jiefang Road, Wuhan 430030,People’s Republic of China华中科技大学同济医学院附属同济医院[6]Department of Critical Care Medicine, The FirstAffiliated Hospital of China Medical University, 155 North Nanjing Street,Shenyang 110001, People’s Republic of China[7]Department of Critical CareMedicine, West China Hospital, Sichuan University, 37 Guoxue Alley,Chengdu 610041, People’s Republic of China四川大学华西医院[8]Department of Critical CareMedicine, The First Affiliated Hospital, Chongqing Medical University, 1 YouyiRoad, Yuanjiagang, Chongqing 400016, People’s Republic of China外科系统重症医学科重庆医科大学附属第一医院[9]Department of Critical Care Medicine, Hainan Provincial People’s Hospital,No.19 Xiuhua Road, Haikou 570311, People’s Republic of China[10]Department of Critical Care Medicine, Guangdong General Hospital, 106Zhongshan Er Road, Guangzhou 510080, People’s Republic of China其他科室急危重症医学部广东省人民医院[11]Department of Emergency and Critical Care Medicine, The Second Hospitalof Jilin University, 18 Ziqiang Street, Changchun 130041, People’s Republic ofChina[12]Department of Critical Care Medicine, Fuxing Hospital, CapitalMedical University, A20 Fuxingmenwai Street, Beijing 100038, People’sRepublic of China[13]Department of Critical Care Medicine, Hebei MedicalUniversity Fourth Hospital, 12 Jiankang Road, Shijiazhuang 050011, People’sRepublic of China河北医科大学第四医院[14]Department of Critical Care Medicine, ZhejiangProvincial People’s Hospital, 158 Shangtang Road, Hangzhou 310014,People’s Republic of China[15]Department of Critical Care Medicine, The FirstAffiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou350005, People’s Republic of China[16]Department of Critical Care Medicine,Beijing Tongren Hospital, Capital Medical University, 2 ChongwenmenneiStreet, Beijing 100730, People’s Republic of China首都医科大学附属同仁医院[17]Department of CriticalCare Medicine, Qilu Hospital, Shandong University, 107 Wenhua Xi Road,Jinan 250012, People’s Republic of China[18]Department of Critical CareMedicine, Peking University People’s Hospital, 11 Xizhimen South Street,Beijing 100044, People’s Republic of China[19]Department of Critical CareMedicine, Xiangya Hospital, Central South University, 87 Xiangya Road,Changsha 410008, People’s Republic of China[20]Department of Critical CareMedicine, The Affiliated Hospital of Inner Mongolia Medical College, 1Tongdao North Street, Huhhot 010050, People’s Republic of China[21]Department of Critical Care Medicine, Affiliated Hospital of Ningxia MedicalUniversity, 804 Shengli South Street, Yinchuan 750004, People’s Republic ofChina[22]Surgical ICU, Department of Anesthesia, Xijing Hospital, 127 ChangLe Xi Road, Xi’an 710032, People’s Republic of China[23]Surgical ICU, The FirstAffiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou450052, Henan, People’s Republic of China[24]Ruijin Hospital, Shanghai JiaoTong University, No .197 Ruijin Er Road, Shanghai 200025, People’s Republicof China
Background: Poor inter-rater reliability in chest radiograph interpretation has been reported in the context of acute respiratory distress syndrome (ARDS), although not for the Berlin definition of ARDS. We sought to examine the effect of training material on the accuracy and consistency of intensivists' chest radiograph interpretations for ARDS diagnosis. Methods: We conducted a rater agreement study in which 286 intensivists (residents 41.3%, junior attending physicians 35.3%, and senior attending physician 23.4%) independently reviewed the same 12 chest radiographs developed by the ARDS Definition Task Force ("the panel") before and after training. Radiographic diagnoses by the panel were classified into the consistent (n = 4), equivocal (n = 4), and inconsistent (n = 4) categories and were used as a reference. The 1.5-hour training course attended by all 286 intensivists included introduction of the diagnostic rationale, and a subsequent in-depth discussion to reach consensus for all 12 radiographs. Results: Overall diagnostic accuracy, which was defined as the percentage of chest radiographs that were interpreted correctly, improved but remained poor after training (42.0 +/- 14.8% before training vs. 55.3 +/- 23.4% after training, p < 0.001). Diagnostic sensitivity and specificity improved after training for all diagnostic categories (p < 0.001), with the exception of specificity for the equivocal category (p = 0.883). Diagnostic accuracy was higher for the consistent category than for the inconsistent and equivocal categories (p < 0.001). Comparisons of pre-training and post-training results revealed that inter-rater agreement was poor and did not improve after training, as assessed by overall agreement (0.450 +/- 0.406 vs. 0.461 +/- 0.575, p = 0.792), Fleiss's kappa (0.133 +/- 0.575 vs. 0.178 +/- 0.710, p = 0.405), and intraclass correlation coefficient (ICC; 0.219 vs. 0.276, p = 0.470). Conclusions: The radiographic diagnostic accuracy and inter-rater agreement were poor when the Berlin radiographic definition was used, and were not significantly improved by the training set of chest radiographs developed by the ARDS Definition Task Force.
第一作者机构：[1]Medical ICU, Peking Union Medical College Hospital, 1 Shuai Fu Yuan,Beijing 100730, People’s Republic of China
通讯作者：
推荐引用方式(GB/T 7714)：
Jin-Min Peng,Chuan-Yun Qian,Xiang-You Yu,et al.Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study[J].CRITICAL CARE.2017,21:doi:10.1186/s13054-017-1606-4.
APA：
Jin-Min Peng,Chuan-Yun Qian,Xiang-You Yu,Ming-Yan Zhao,Shu-Sheng Li...&for the China Critical Care Clinical Trial Group.(2017).Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study.CRITICAL CARE,21,
MLA：
Jin-Min Peng,et al."Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study".CRITICAL CARE 21.(2017)
医学