The Inter-Rater Reliability of Pediatric Point-of-Care Lung Ultrasound Interpretation in Children With Acute Respiratory Failure

Ryan L DeSanti; Eileen A Cowan; Pierre D Kory; Michael R Lasarev; Jessica Schmidt; Awni M Al-Subu

doi:10.1002/jum.15805

The Inter-Rater Reliability of Pediatric Point-of-Care Lung Ultrasound Interpretation in Children With Acute Respiratory Failure

J Ultrasound Med. 2022 May;41(5):1159-1167. doi: 10.1002/jum.15805. Epub 2021 Aug 11.

Authors

Ryan L DeSanti¹, Eileen A Cowan², Pierre D Kory³, Michael R Lasarev⁴, Jessica Schmidt⁵, Awni M Al-Subu²

Affiliations

¹ Department of Pediatrics, Drexel College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA, USA.
² Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
³ Department of Medicine, Advocate Aurora Health Care, St Luke's Medical Center, Milwaukee, WI, USA.
⁴ Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁵ Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Abstract

Objectives: Use of point-of-care lung ultrasound (POC-LUS) has increased significantly in pediatrics yet it remains under-studied in the pediatric intensive care unit (PICU). No studies explicitly evaluate the reliability of POC-LUS artifact interpretation among critically ill children with acute respiratory failure (ARF) in the PICU. We thus designed this study to determine the inter-rater reliability of POC-LUS interpretation in pediatric ARF among pediatric intensivists trained in POC-LUS and an expert intensivist.

Methods: We compared the interpretation of lung sliding, pleural line characteristics, ultrasound artifacts, and POC-LUS diagnoses among pediatric intensivists and an expert intensivist in a cohort of children admitted to the PICU for ARF. Kappa statistics (k) adjusted for maximum attainable agreement (k/k_max ) were used to quantify chance-correct agreement between the pediatric intensivist and expert physician.

Results: We enrolled 88 patients, evaluating 3 zones per hemithorax (anterior, lateral, and posterior) for lung sliding, pleural line characteristics, ultrasound artifacts, and diagnosis. There was moderate agreement between the PICU intensivist and expert-derived diagnoses with 56% observed agreement (k/k_max = 0.46, 95% confidence interval [CI] 0.31-0.65). Agreement in identification of lung sliding (k = 0.19, 95% CI -0.17 to 0.56) and pleural line characteristics (k = 0.24, 95% CI 0.08-0.40) was slight and fair, respectively, while agreement in the interpretation of ultrasound artifacts ranged from moderate to substantial.

Conclusions: Evidence supporting the evaluation of neonatal and adult patients with POC-LUS should not be extrapolated to critically ill pediatric patients. This study adds to the evidence supporting use of POC-LUS in the PICU by demonstrating moderate agreement between PICU intensivist and expert-derived POC-LUS diagnoses.

Keywords: acute respiratory failure; critical care; diagnostic imaging; lung ultrasound; pediatrics; point-of-care ultrasound.

MeSH terms

Adult
Child
Critical Illness
Humans
Infant, Newborn
Lung / diagnostic imaging
Pediatrics*
Point-of-Care Systems
Reproducibility of Results
Respiratory Distress Syndrome*
Respiratory Insufficiency* / diagnostic imaging
Ultrasonography

Abstract

MeSH terms

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