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背景:呼吸系统疾病三级医疗保健中心。 目的:胸部X线检查是结核病(TB)筛查和诊断的一个主要工具。我们对申请到加拿大的移民的活动性结核病筛查的X线胸片分类系统的重复性进行评价。我们同样对这个分类系统关于筛查的移民、结核菌素阳性的密切接触者及具有相应症状的病人中活动性病例发现的可靠性进行评价。 方法:以随机抽取筛查胸片中10％的样本进行复读来评价其重复性。可靠性由经过详细临床评价的病人的最终临床和细菌学诊断来评定。 结果:阅读者之间用五种粗略分类的一致性是中等的(0.44-0.56 Kappa),而阅读者内的一致性更真实(0.59-0.72 Kappa)。经过年龄和病人组调整后,活动性结核病的调整比值比与正常或微小发现或肉芽肿、纤维化改变的比为10.2(95％可信区间[CI]3.2-33);团块或者胸膜腔渗液为11.6(95％CI3.6-37);实质性浸润的为46.1(95％CI 18-117)。结核菌素阳性的密切接触者中,如果X线胸片显示出团块、胸膜病变或者实质性浸润的,成为活动性结核病的几率大于50％。 结论:与结核病有关的X线胸片异常的五种粗略类型的简单分类,阅读具有中等到很好的重复性,有一定的可靠性。
Background: Respiratory Diseases Level 3 Health Care Center. OBJECTIVE: Chest X-ray examination is a major tool for screening and diagnosis of tuberculosis (TB). We evaluate the reproducibility of the X-ray classification system for active tuberculosis screening of immigrants applying to Canada. We also evaluate the reliability of this classification system for the detection of active cases in screening immigrants, tuberculin-positive close contacts, and patients with corresponding symptoms. Methods: Randomly selected 10% of the screening chest X-ray samples were repeated to evaluate the repeatability. Reliability is assessed by the final clinical and bacteriological diagnosis of patients who have undergone detailed clinical evaluation. Results: Consistency among the readers using the five crude categories was modest (0.44-0.56 Kappa), while reader consensus was more realistic (0.59-0.72 Kappa). After adjustment for age and patient group, the odds ratio for active TB was 10.2 (95% confidence interval [CI]) compared with normal or minimal findings or granuloma and fibrosis changes; mass or pleural cavity Exudate was 11.6 (95% CI 3.6-37); substantive infiltration was 46.1 (95% CI 18-117). Among tuberculin-positive close contacts, the chance of becoming active TB is more than 50% if the X-ray shows a mass, pleural disease, or substantial infiltration. CONCLUSIONS: Five simple categories of tuberculosis-related chest radiographs with a simple classification of readings have moderate to good repeatability with some reliability.