Interrater reliability in assigning a lung ultrasound score

Louise Hansell; Maree Milross; Anthony Delaney; David H Tian; George Ntoumenopoulos

doi:10.1016/j.aucc.2022.10.008

Interrater reliability in assigning a lung ultrasound score

Aust Crit Care. 2023 Sep;36(5):732-736. doi: 10.1016/j.aucc.2022.10.008. Epub 2022 Nov 17.

Authors

Louise Hansell¹, Maree Milross², Anthony Delaney³, David H Tian⁴, George Ntoumenopoulos⁵

Affiliations

¹ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, Australia. Electronic address: Louise.Hansell@health.nsw.gov.au.
² Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: Maree.Milross@sydney.edu.au.
³ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Division of Critical Care, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia; ANZIC Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. Electronic address: ADelaney@georgeinstitute.org.au.
⁴ Division of Critical Care, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Australia. Electronic address: drdavidtian@gmail.com.
⁵ Physiotherapy Department, St Vincent's Hospital, Sydney, Australia. Electronic address: georgentou@yahoo.com.

PMID: 36404268
DOI: 10.1016/j.aucc.2022.10.008

Abstract

Background and purpose: Lung ultrasound (LUS) for physiotherapists is an emerging bedside tool. The LUS score of aeration presents as a possible means of assessing and monitoring lung aeration associated with respiratory physiotherapy treatments. There are no studies to date that have assessed the interrater reliability (IRR) of physiotherapists assigning the LUS score of aeration. This study assessed the IRR of assigning the LUS score among adult, mechanically ventilated patients in an intensive care unit with a clinical suspicion of acute lobar atelectasis.

Methods: A convenience sample of patients had an LUS performed by a physiotherapist, and images were independently reviewed by two physiotherapists. Each lung zone was assigned an LUS score between 0 and 3 (with 0 being normal aeration and 3 being complete consolidation, presence of effusion, or pneumothorax). IRR was assessed using the kappa statistic.

Results: A total of 1032 LUS images were obtained. Assigning of the LUS across all lung zones demonstrated substantial agreement with kappa 0.685 (95% confidence interval: 0.650, 0.720). Right (0.702 [0.653, 0.751]) and left (0.670 [0.619, 0.721]) lung zones also demonstrated substantial agreement.

Conclusion: We found substantial IRR between physiotherapists in assigning the LUS score in a mechanically ventilated adult population in the intensive care unit.

Australian new zealand clinical trials registration number: ACTRN12619000783123.

Keywords: Intensive care; Interrater reliability; Lung ultrasound; POCUS; Respiratory physiotherapy.

MeSH terms

Adult
Australia
Humans
Intensive Care Units*
Lung* / diagnostic imaging
Reproducibility of Results
Ultrasonography / methods