Does training improve diagnostic accuracy and inter-rater agreement in applying the Berlin radiographic definition of acute respiratory distress syndrome? A multicenter prospective study

作者：Jinmin Peng, Chuanyun Qian, Xiangyou Yu, Mingyan Zhao, Shusheng Li, Xiaochun Ma, Yan Kang, Fachun Zhou, Zhenyang He, Tiehe Qin, Yongjie Yin, Li Jiang, Zhenjie Hu, Renhua Sun, Jiandong Lin, Tong Li, Dawei Wu, Youzhong An, Yuhang Ai, Lihua Zhou, Xiangyuan Cao, Xijing Zhang, Rongqing Sun, Erzhen Chen, Bin Du · 发表于：Critical Care · 年份：2017 · DOI：10.1186/s13054-017-1606-4 · 被引用次数：38 · 研究领域：Ultrasound in Clinical Applications、Sepsis Diagnosis and Treatment、Clinical Reasoning and Diagnostic Skills

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 catego...