Inter-observer Variability for Radiography in Pediatric Acute Respiratory Distress Syndrome and Improvement with a Computer-Aided Diagnosis System

Acute respiratory distress syndrome (ARDS) is the most severe form of acute respiratory failure both in adult and children. The Consensus Conference on ARDS definition requires the presence of bilateral pulmonary infiltrates on chest X-ray (CXR). To be consistently useful, interpretation of the CXR must be reliable. Adult studies on radiographic interpretation in ARDS have shown limited inter-observer agreement and concluded that intensivists without formal consensus training can only achieve a moderate level of agreement. In order to improve this agreement level, a computer-aided diagnosis (CAD) system was developed. Objective: To compare the reliability of radiological diagnosis of P-ARDS between clinical assessment and a CAD system. Design: Retrospective radiological study. Patients: Chest X ray of children admitted in a pediatric intensive care unit between April 1, 2009 and April 30, 2010. Measurements: a CXR database was developed using 90 CXR selected among children included in a previous study. We developed a methodology to create a gold standard for the radiological diagnosis of ARDS. We compared the inter-observer variability for radiological ARDS diagnosis between two intensivists and the CAD. Results: Inter-observer variability was moderate between two intensivists (kappa: 0.55). The CAD system was able to significantly improve the kappa score either alone or as second reader (0.77 and 0.79-0.86 respectively) and reach a good agreement level. Conclusion: Our study confirms the inter-observer variability with clinical assessment alone. The use of a CAD system for CXR interpretation in pediatric ARDS is able to reduce variability.