Exploring Inter‐Rater Agreement in Classification of Radiological Features of Tension in Adults With Primary Spontaneous Pneumothorax

Objective To explore agreement between emergency physicians in classifying chest x‐rays (CXR) of patients with primary spontaneous pneumothorax (PSP) as showing the presence/absence of so‐called radiological tension features. Methods Observational study. Five emergency physicians blinded to patient characteristics, radiologist report, patient outcome and other reviewers' classification assessed each of 80 PSP CXR and classified them as showing radiological tension features or not. Analysis using Krippendorff's Alpha (K‐Alpha). Results Inter‐rater agreement was 0.524 (95% CI: 0.400–0.623)—consistent with poor agreement. Conclusion Interpretation for radiological tension features had poor inter‐rater reliability, which seriously changes their appropriateness as drivers for interventional management.