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.;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.;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).;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.;The study was registered at ClinicalTrials.gov (registration number NCT01704066 ) on 6 October 2012.;
[1]Peking Union Med Coll Hosp, Med ICU, 1 Shuai Fu Yuan, Beijing 100730, Peoples R China.
[2]Kunming Med Univ, Affiliated Hosp 1, Dept Emergency Med, 295 Xichang St, Kunming 650032, Peoples R China.
[3]Xinjiang Med Univ, Affiliated Hosp 1, Dept Crit Care Med, 1 Liyushan Rd, Urumqi 830054, Peoples R China.
[4]Harbin Med Univ, Dept Crit Care Med, Affiliated Hosp 1, 23 Youzheng St, Harbin 150001, Peoples R China.
[5]Huazhong Univ Sci & Technol, Dept Crit Care Med, Tongji Hosp, Tongji Med Coll, 1095 Jiefang Rd, Wuhan 430030, Peoples R China.
[6]China Med Univ, Dept Crit Care Med, Affiliated Hosp 1, 155 North Nanjing St, Shenyang 110001, Peoples R China.
[7]Sichuan Univ, Dept Crit Care Med, West China Hosp, 37 Guoxue Alley, Chengdu 610041, Peoples R China.
[8]Chongqing Med Univ, Dept Crit Care Med, Affiliated Hosp 1, 1 Youyi Rd, Chongqing 400016, Peoples R China.
[9]Hainan Prov Peoples Hosp, Dept Crit Care Med, 19 Xiuhua Rd, Haikou 570311, Peoples R China.
[10]Guangdong Gen Hosp, Dept Crit Care Med, 106 Zhongshan Er Rd, Guangzhou 510080, Guangdong, Peoples R China.
[11]Jilin Univ, Dept Emergency & Crit Care Med, Hosp 2, 18 Ziqiang St, Changchun 130041, Peoples R China.
[12]Capital Med Univ, Fuxing Hosp, Dept Crit Care Med, A20 Fuxingmenwai St, Beijing 100038, Peoples R China.
[13]Hebei Med Univ, Dept Crit Care Med, Hosp 4, 12 Jiankang Rd, Shijiazhuang 050011, Peoples R China.
[14]Zhejiang Prov Peoples Hosp, Dept Crit Care Med, 158 Shangtang Rd, Hangzhou 310014, Zhejiang, Peoples R China.
[15]Fujian Med Univ, Dept Crit Care Med, Affiliated Hosp 1, 20 Chazhong Rd, Fuzhou 350005, Peoples R China.
[16]Capital Med Univ, Dept Crit Care Med, Beijing Tongren Hosp, 2 Chongwenmennei St, Beijing 100730, Peoples R China.
[17]Shandong Univ, Dept Crit Care Med, Qilu Hosp, 107 Wenhua Xi Rd, Jinan 250012, Peoples R China.
[18]Peking Univ, Dept Crit Care Med, Peoples Hosp, 11 Xizhimen South St, Beijing 100044, Peoples R China.
[19]Cent South Univ, Dept Crit Care Med, Xiangya Hosp, 87 Xiangya Rd, Changsha 410008, Hunan, Peoples R China.
[20]Inner Mongolia Med Coll, Dept Crit Care Med, Affiliated Hosp, 1 Tongdao North St, Hohhot 010050, Peoples R China.
[21]Ningxia Med Univ, Dept Crit Care Med, Affiliated Hosp, 804 Shengli South St, Yinchuan 750004, Peoples R China.
[22]Xijing Hosp, Dept Anesthesia, Surg ICU, 127 Chang Le Xi Rd, Xian 710032, Peoples R China.
[23]Zhengzhou Univ, Surg ICU, Affiliated Hosp 1, 1 Jianshe Rd, Zhengzhou 450052, Henan, Peoples R China.
[24]Shanghai Jiao Tong Univ, Ruijin Hosp, 197 Ruijin Er Rd, Shanghai 200025, Peoples R China.
(8.0+极速模式)