Abstract
Background
Lung ultrasonography (LUS) is a non-invasive imaging method used to diagnose and monitor conditions such as pulmonary edema, pneumonia, and pneumothorax. It is precious where other imaging techniques like CT scan or chest X-rays are of limited access, especially in low- and middle-income countries with reduced resources. Furthermore, LUS reduces radiation exposure and its related blood cancer adverse events, which is particularly relevant in children and young subjects. The score obtained with LUS allows semi-quantification of regional loss of aeration, and it can provide a valuable and reliable assessment of the severity of most respiratory diseases. However, inter-observer reliability of the score has never been systematically assessed. This study aims to assess experienced LUS operators’ agreement on a sample of video clips showing predefined findings.
Methods
Twenty-five anonymized video clips comprehensively depicting the different values of LUS score were shown to renowned LUS experts blinded to patients’ clinical data and the study’s aims using an online form. Clips were acquired from five different ultrasound machines. Fleiss-Cohen weighted kappa was used to evaluate experts’ agreement.
Results
Over a period of 3 months, 20 experienced operators completed the assessment. Most worked in the ICU (10), ED (6), HDU (2), cardiology ward (1), or obstetric/gynecology department (1). The proportional LUS score mean was 15.3 (SD 1.6). Inter-rater agreement varied: 6 clips had full agreement, 3 had 19 out of 20 raters agreeing, and 3 had 18 agreeing, while the remaining 13 had 17 or fewer people agreeing on the assigned score. Scores 0 and score 3 were more reproducible than scores 1 and 2. Fleiss’ Kappa for overall answers was 0.87 (95% CI 0.815–0.931, p < 0.001).
Conclusions
The inter-rater agreement between experienced LUS operators is very high, although not perfect. The strong agreement and the small variance enable us to say that a 20% tolerance around a measured value of a LUS score is a reliable estimate of the patient's true LUS score, resulting in reduced variability in score interpretation and greater confidence in its clinical use.
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Details
1 San Giovanni Bosco Hospital, Department of Anaesthesia and Intensive Care Unit, Turin, Italy (GRID:grid.415044.0) (ISNI:0000 0004 1760 7116)
2 University of Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa, Italy (GRID:grid.5395.a) (ISNI:0000 0004 1757 3729)
3 Keenan Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto (St. Michael’s Hospital), Toronto, Canada (GRID:grid.5395.a); University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Canada (GRID:grid.17063.33) (ISNI:0000 0001 2157 2938)
4 Barts Health NHS Trust, Emergency Department, London, UK (GRID:grid.139534.9) (ISNI:0000 0001 0372 5777)
5 Saint Bartholomew’s Hospital, London, UK (GRID:grid.416353.6) (ISNI:0000 0000 9244 0345); Gabriele d’Annunzio University of Chieti-Pescara, Department of Innovative Technologies in Medicine and Dentistry, Chieti, Italy (GRID:grid.412451.7) (ISNI:0000 0001 2181 4941)
6 Saint Bartholomew’s Hospital, London, UK (GRID:grid.416353.6) (ISNI:0000 0000 9244 0345); Gabriele d’Annunzio University of Chieti-Pescara, Department of Innovative Technologies in Medicine and Dentistry, Chieti, Italy (GRID:grid.412451.7) (ISNI:0000 0001 2181 4941); SS. Annunziata Hospital, Department of Anesthesiology, Critical Care Medicine and Emergency, Chieti, Italy (GRID:grid.412451.7)
7 Buzzi Children’s Hospital, Division of Pediatric Anesthesia and Intensive Care, Milan, Italy (GRID:grid.415044.0)
8 University of Udine, Department of Medicine, Udine, Italy (GRID:grid.5390.f) (ISNI:0000 0001 2113 062X)
9 National Research Council, Institute of Clinical Physiology, Lecce, Italy (GRID:grid.5326.2) (ISNI:0000 0001 1940 4177)
10 Università del Piemonte Orientale, Department of Translational Medicine, Novara, Italy (GRID:grid.16563.37) (ISNI:0000000121663741)
11 Tor Vergata’ University of Rome, Department of Clinical Science and Translational Medicine, Rome, Italy (GRID:grid.6530.0) (ISNI:0000 0001 2300 0941)
12 University of Parma, Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, Parma, Italy (GRID:grid.10383.39) (ISNI:0000 0004 1758 0937)
13 Health Integrated Agency of Friuli Centrale, Department of Anaesthesia and Intensive Care, Udine, Italy (GRID:grid.10383.39)
14 Magna Graecia University, Department of Medical and Surgical Science, Catanzaro, Italy (GRID:grid.411489.1) (ISNI:0000 0001 2168 2547)
15 SS. Annunziata Hospital, Department of Anesthesiology, Critical Care Medicine and Emergency, Chieti, Italy (GRID:grid.415044.0); University of Chieti-Pescara, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy (GRID:grid.412451.7) (ISNI:0000 0001 2181 4941)