External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TB
BACKGROUND: Chest X-ray (CXR) misinterpretation negatively affects the accuracy of childhood TB diagnosis. External quality assurance (EQA) could strengthen CXR reading skills. We assessed the uptake, performance and challenges of an EQA of CXR interpretation within the childhood TB-Speed decentrali...
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| Format: | Article |
| Language: | English |
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International Union Against Tuberculosis and Lung Disease (The Union)
2024-10-01
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| Series: | IJTLD Open |
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| Online Access: | https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000010/art00005 |
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| author | B.F. Melingui E. Leroy-Terquem J.V. Taguebue T.C. Eap L. Borand C. Khosa R. Moh J. Mwanga-Amumpaire S. Beneteau M.T. Eang I. Manhiça A. Mustapha O. Marcy E. Wobudeya P.Y. Norval M. Bonnet on behalf of the TB-Speed study group |
| author_facet | B.F. Melingui E. Leroy-Terquem J.V. Taguebue T.C. Eap L. Borand C. Khosa R. Moh J. Mwanga-Amumpaire S. Beneteau M.T. Eang I. Manhiça A. Mustapha O. Marcy E. Wobudeya P.Y. Norval M. Bonnet on behalf of the TB-Speed study group |
| author_sort | B.F. Melingui |
| collection | DOAJ |
| description | BACKGROUND: Chest X-ray (CXR) misinterpretation negatively affects the accuracy of childhood TB diagnosis. External quality assurance (EQA) could strengthen CXR reading skills. We assessed the uptake, performance and challenges of an EQA of CXR interpretation within the childhood TB-Speed decentralisation study in six resource-limited countries. METHODS: Every quarter, TB suggestive or unreadable CXRs and 10% of remaining CXRs from children with presumptive TB were selected for blind re-reading by national re-readers. The proportion of CXRs selected for EQA and re-read assessed the uptake. The performance was assessed by the proportion of discordant interpretations and the sensitivity and specificity of clinicians’ vs re-readers’ interpretations. Challenges were retrieved from country reports. RESULTS: Of 513 eligible CXRs, 309 (60.8%) were selected for EQA and 278/309 (90.0%) re-read. The proportion of discordant interpretation was between 13/48 (27%) in Sierra Leone and 7/13 (53.8%) in Cote d’Ivoire during the first EQA and decreased after the EQAs periods in 3/5 countries. Clinician sensitivity reached 100% in all countries over EQA. Specificity ranged between 13% in Sierra Leone and 65% in Cambodia (first EQA) and increased in 4/5 countries after the EQA periods. CXR transfer and re-readers’ workload were the main challenges. CONCLUSION: EQA can enhance CXR interpretation for childhood TB diagnosis, provided operational challenges are overcome. |
| format | Article |
| id | doaj-art-3d97f622b4f14653bab330c200709bd7 |
| institution | Kabale University |
| issn | 3005-7590 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | International Union Against Tuberculosis and Lung Disease (The Union) |
| record_format | Article |
| series | IJTLD Open |
| spelling | doaj-art-3d97f622b4f14653bab330c200709bd72025-01-23T13:28:38ZengInternational Union Against Tuberculosis and Lung Disease (The Union)IJTLD Open3005-75902024-10-0111044945510.5588/ijtldopen.24.03285External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TBB.F. Melingui0E. Leroy-Terquem1J.V. Taguebue2T.C. Eap3L. Borand4C. Khosa5R. Moh6J. Mwanga-Amumpaire7S. Beneteau8M.T. Eang9I. Manhiça10A. Mustapha11O. Marcy12E. Wobudeya13P.Y. Norval14M. Bonnet15on behalf of the TB-Speed study groupInstitut de Recherche pour le développement (IRD), University of Montpellier, Montpellier, France;François Quesnay Hospital, International Pulmonology Support, Mantes-la-Jolie, France;Mother and Child Center, Chantal Biya Foundation, Yaoundé, Cameroon;National Tuberculosis Programme, Ministry of Health, Phnom Penh, Cambodia;Institut Pasteur of Cambodia, Epidemiology and Public Health Unit, Clinical Research Group, Phnom Penh, Cambodia;National Institute of Health, Marracuene, Mozambique;Programme d’Action Coordonné - Cote d’Ivoire, Treichville University Hospital, Abidjan, Côte d'Ivoire;Epicentre Mbarara Research Centre, Mbarara, Uganda;Institut de Recherche pour le développement (IRD), University of Montpellier, Montpellier, France;National Center for Tuberculosis and Leprosy, Ministry of Health, Phnom Penh, Cambodia;National Tuberculosis Control Programme, Ministry of Health, Maputo, Mozambique;Ola During Children’s Hospital, Freetown, Sierra Leone;University of Bordeaux, Institut national de la santé et de la recherche médicale, Unité mixte de Recherche 1219, IRD, Bordeaux, France;Makerere University–Johns Hopkins University Research Collaboration Care, Kampala, Uganda;Technical Assistance for Management, Paris, France.Institut de Recherche pour le développement (IRD), University of Montpellier, Montpellier, France;BACKGROUND: Chest X-ray (CXR) misinterpretation negatively affects the accuracy of childhood TB diagnosis. External quality assurance (EQA) could strengthen CXR reading skills. We assessed the uptake, performance and challenges of an EQA of CXR interpretation within the childhood TB-Speed decentralisation study in six resource-limited countries. METHODS: Every quarter, TB suggestive or unreadable CXRs and 10% of remaining CXRs from children with presumptive TB were selected for blind re-reading by national re-readers. The proportion of CXRs selected for EQA and re-read assessed the uptake. The performance was assessed by the proportion of discordant interpretations and the sensitivity and specificity of clinicians’ vs re-readers’ interpretations. Challenges were retrieved from country reports. RESULTS: Of 513 eligible CXRs, 309 (60.8%) were selected for EQA and 278/309 (90.0%) re-read. The proportion of discordant interpretation was between 13/48 (27%) in Sierra Leone and 7/13 (53.8%) in Cote d’Ivoire during the first EQA and decreased after the EQAs periods in 3/5 countries. Clinician sensitivity reached 100% in all countries over EQA. Specificity ranged between 13% in Sierra Leone and 65% in Cambodia (first EQA) and increased in 4/5 countries after the EQA periods. CXR transfer and re-readers’ workload were the main challenges. CONCLUSION: EQA can enhance CXR interpretation for childhood TB diagnosis, provided operational challenges are overcome.https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000010/art00005external quality assurancetuberculosisdiagnosischildrenchest x-raylimited-resources countries |
| spellingShingle | B.F. Melingui E. Leroy-Terquem J.V. Taguebue T.C. Eap L. Borand C. Khosa R. Moh J. Mwanga-Amumpaire S. Beneteau M.T. Eang I. Manhiça A. Mustapha O. Marcy E. Wobudeya P.Y. Norval M. Bonnet on behalf of the TB-Speed study group External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TB IJTLD Open external quality assurance tuberculosis diagnosis children chest x-ray limited-resources countries |
| title | External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TB |
| title_full | External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TB |
| title_fullStr | External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TB |
| title_full_unstemmed | External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TB |
| title_short | External quality assurance of chest X-ray interpretation to strengthen diagnosis of childhood TB |
| title_sort | external quality assurance of chest x ray interpretation to strengthen diagnosis of childhood tb |
| topic | external quality assurance tuberculosis diagnosis children chest x-ray limited-resources countries |
| url | https://www.ingentaconnect.com/contentone/iuatld/ijtldo/2024/00000001/00000010/art00005 |
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