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- Title
The Inter‐Rater Reliability of Pediatric Point‐of‐Care Lung Ultrasound Interpretation in Children With Acute Respiratory Failure.
- Authors
DeSanti, Ryan L.; Cowan, Eileen A.; Kory, Pierre D.; Lasarev, Michael R.; Schmidt, Jessica; Al‐Subu, Awni M.
- 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/kmax) 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/kmax = 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.
- Subjects
LUNGS; ADULT respiratory distress syndrome; CRITICALLY ill children; ULTRASONIC imaging; PEDIATRIC intensive care; POINT-of-care testing
- Publication
Journal of Ultrasound in Medicine, 2022, Vol 41, Issue 5, p1159
- ISSN
0278-4297
- Publication type
Article
- DOI
10.1002/jum.15805