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World Health Organization (WHO) radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia.    Methods  An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification.    Results  There was significant disagreement (22%) between the first and second reports (kappa = 0.70,  P <0.001), notably in those aged <5 years (26%, kappa = 0.66,  P <0.001). The most frequent sources of disagreement were the reporting of patchy and perihilar changes.    Conclusion  This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children.

Accuracy of the Interpretation of Chest Radiographs for the Diagnosis of Paediatric Pneumonia