Interobserver Reliability and Accuracy of Cranial Ultrasound Scanning Interpretation in Premature Infants

George Washington University, Washington, Washington, D.C., United States
The Journal of pediatrics (Impact Factor: 3.79). 07/2007; 150(6):592-6, 596.e1-5. DOI: 10.1016/j.jpeds.2007.02.012
Source: PubMed


To assess interobserver reliability between 2 central readers of cranial ultrasound scanning (CUS) and accuracy of local, compared with central, interpretations.
The study was a retrospective analysis of CUS data from the National Institute of Child Health and Human Development (NICHD) trial of inhaled nitric oxide for premature infants. Interobserver reliability of 2 central readers was assessed with kappa or weighted kappa. Accuracy of local, compared with central, interpretations was assessed by using sensitivity and specificity.
CUS from 326 infants had both central reader and local interpretations. Central reader agreement for grade 3/4 intraventricular hemorrhage (IVH), grade 3/4 IVH or periventricular leukomalacia (PVL), grade of IVH, and degree of ventriculomegaly was very good (kappa = 0.84, 0.81, 0.79, and 0.75, respectively). Agreement was poor for lower grade IVH and for PVL alone. Local interpretations were highly accurate for grade 3/4 IVH or PVL (sensitivity, 87%-90%; specificity, 92%-93%), but sensitivity was poor-to-fair for grade 1/2 IVH (48%-68%) and PVL (20%-44%).
Our findings demonstrate reliability and accuracy of highly unfavorable CUS findings, but suggest caution when interpreting mild to moderate IVH or white matter injury.

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Available from: Krisa P Vanmeurs, Dec 13, 2013
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    • "This restriction was put in place because the likelihood of detecting abnormalities is greater with serial scans than with a single scan, and because we planned to compare the performance of preterm children with and without ultrasound-based evidence of PVBI. While structural or quantitative magnetic resonance imaging, and/or diffusion tensor imaging would have provided more sensitive measures of neurological damage (e.g., Anderson et al., 2004; Cooke, 1999; Counsell et al., 2003; Goto et al., 1994; Hintz et al., 2007; Maalouf et al., 2001), the preterm children who participated in the present study were not routinely scanned using these more sophisticated techniques. Full-term control children, born without medical complication and having no history of developmental problems, were recruited through elementary schools and daycare centres in the community via recruitment letters, posters, and word-of- mouth. "
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