DefinePK

Abstract

Background: Pneumoperitoneum, the presence of free intraperitoneal air, is a critical radiological finding often indicative of gastrointestinal perforation and requires immediate intervention. Early detection using plain radiographs is essential, especially in resource-limited settings where advanced imaging may not be readily available. However, interpretation accuracy may vary with clinical experience, particularly during on-call hours when junior residents are primarily responsible for initial assessments. Establishing the reliability of resident interpretations is vital to improving diagnostic workflows and patient outcomes.
Objective: To assess the level of diagnostic concordance between junior radiology residents and consultant radiologists in identifying pneumoperitoneum on plain radiographs and to analyze variations across demographic and clinical subgroups.
Methods: A cross-sectional study was conducted over six months (December 9, 2021, to June 8, 2022) at the Department of Diagnostic Radiology, Aga Khan University Hospital, Karachi. A total of 100 radiographs were prospectively analyzed. First- and second-year FCPS-II radiology residents independently assessed anonymized plain radiographs for signs of pneumoperitoneum, categorizing each as negative or requiring urgent attention. These preliminary evaluations were then compared with final consultant reports. Inter-observer agreement was quantified using Cohen’s Kappa statistic, with stratification based on age, gender, patient location, radiographic technique, and residency year.
Results: The mean age of the patients was 38.09 ± 17.48 years, with 61.0% male and 39.0% female participants. Junior residents identified pneumoperitoneum in 26 cases, while consultant radiologists confirmed 74 cases. Diagnostic concordance was observed in 82 out of 100 cases. The Kappa coefficient was 0.520 (95% CI: 0.327–0.714, p < 0.001), indicating moderate agreement. Substantial agreement was found among patients aged <60 years (κ = 0.684), females (κ = 0.692), and ICU/outpatient settings (κ = 0.750, κ = 0.765). Decubitus radiographs demonstrated perfect agreement (κ = 1.000), while supine views showed lower agreement (κ = 0.298).
Conclusion: This study demonstrates moderate yet statistically significant diagnostic agreement between junior residents and consultants in identifying pneumoperitoneum. Variations in concordance across subgroups highlight the need for enhanced supervision, feedback mechanisms, and targeted radiographic interpretation training to improve diagnostic reliability among junior radiologists.