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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    ABSTRACT: Young children born very prematurely show elevated thresholds for global motion and global form [Atkinson, J. & Braddick, O. (2007). Visual and visuocognitive development in children born very prematurely. Progress in Brain Research, 164, 123-149; MacKay, T. L., Jakobson, L. S., Ellemberg, D., Lewis, T. L., Maurer, D., & Casiro, O. (2005). Deficits in the processing of local and global motion in very low birthweight children. Neuropsychologia, 43, 1738-1748]. In adolescence, those with white matter pathology show reduced sensitivity to biological motion [Pavlova, M., Sokolov, A., Staudt, M., Marconato, F., Birbaumer, N., & Krageloh-Mann, I. (2005). Recruitment of periventricular parietal regions in processing cluttered point-light biological motion. Cerebral Cortex, 15, 594-601; Pavlova, M., Staudt, M., Sokolov, A., Birbaumer, N., & Krageloh-Mann, I. (2003). Perception and production of biological movement in patients with early periventricular brain lesions. Brain, 126, 692-701]. Here, we measured sensitivity to global form, global motion, and biological motion in a sample of 23, five- to nine-year-old children born at <32 weeks gestation, and in 20 full-term controls matched to the clinical sample in age, socioeconomic status, and estimated Verbal IQ. As a group, premature children showed reduced sensitivity, relative to controls, on all three tasks (F>4.1, p<0.05). By computing a deficit score for each task (the ratio between a premature child's threshold and the mean threshold for three age-matched controls) we were able to compare performance across tasks directly. Mean deficit scores were significantly greater than 1 (indicating some level of impairment) for biological motion and global motion (ps<0.03). In contrast, the mean deficit score for global form was not significantly different from 1 (indicating no impairment, relative to age-matched control children). Rates of impairment (deficit score>or=2) were four times higher for global motion than for global form (p<0.04); rates of impairment on the biological motion task fell at an intermediate level. In agreement with previous studies, we find impairments in the processing of global motion (Atkinson & Braddick; MacKay et al.) and of biological motion (Pavlova et al.), which are larger than the impairments in the processing of global form (Atkinson & Braddick). In addition, we show that the impairments are not correlated with each other. The differential vulnerability that we observed across tasks could not be accounted for by stereoacuity deficits, amblyopia, or attentional problems. We suspect, instead, that it reflects the fact that these forms of visual processing develop at different rates, and may be differentially vulnerable to early brain injury or atypical neurodevelopment [c.f., Atkinson, J. & Braddick, O. (2007). Visual and visuocognitive development in children born very prematurely. Progress in Brain Research, 164, 123-149; Braddick, O., Atkinson, J., & Wattam-Bell, J. (2003). Normal and anomalous development of visual motion processing: Motion coherence and 'dorsal-stream vulnerability'. Neuropsychologia, 41, 1769-1784].
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