Reliability of Echocardiographic Indicators of Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary Dysplasia.
Reliability of Echocardiographic Indicators of Pulmonary Vascular Disease in Preterm Infants at Risk for Bronchopulmonary Dysplasia.
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DOI：
10.1016/j.jpeds.2017.03.027
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发表时间：
2017-07
期刊：
影响因子：
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通讯作者：
Mourani PM
中科院分区：
文献类型：
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作者：
Carlton EF;Sontag MK;Younoszai A;DiMaria MV;Miller JI;Poindexter BB;Abman SH;Mourani PM
确定超声心动图评估有支气管肺发育不良风险的早产儿肺血管疾病（PVD）的评估和评估者间的可靠性。我们前瞻性地研究了早产儿（出生体重500 - 1250克）在7日龄和经后36周（PMA）时的超声心动图。超声心动图由临床服务的心脏病专家和单一的研究心脏病专家进行评估。对解释进行了审查，以纳入PVD的决定因素，并使用患病率调整偏倚调整Kappa评分评估评估者间的可靠性。7天和36周PMA研究分别有180和188份匹配的研究和临床超声心动图报告。54%的临床报告中至少有一项PVD的具体定性指标缺失。在研究和临床解释中，分别有31%和20%的人在7天内诊断出PVD（Kappa评分为0.54）。在36周时，分别有15.6%和17.8%的研究和临床解释诊断为PH（Kappa评分为0.80）。尽管超声心动图报告中未一致提供PVD的所有定性变量，但心脏病专家评价PVD测量值的评估者间可靠性显示出高度一致，尤其是在36周PMA时。我们推测，建立超声心动图评估方案可能会提高早产儿PVD的识别率。
To determine the assessment and inter-rater reliability of echocardiographic evaluations of pulmonary vascular disease (PVD) in preterm infants at risk for bronchopulmonary dysplasia. We prospectively studied echocardiograms from preterm infants (birthweights 500 – 1250g) at 7 days of age and 36 weeks postmenstrual age (PMA). Echocardiograms were assessed by both a cardiologist on clinical service and a single research cardiologist. Interpretations were reviewed for inclusion of determinants of PVD and assessed for inter-rater reliability using the Prevalence Adjusted Bias Adjusted Kappa Score. 180 and 188 matching research and clinical echocardiogram reports were available for the 7 day and 36 week PMA studies. At least one of the specific qualitative measures of PVD was missing from 54% of the clinical reports. PVD was diagnosed at 7 days in 31% and 20% of research and clinical interpretations, respectively (kappa score of 0.54). At 36 weeks, PH was diagnosed in 15.6% and 17.8% of research and clinical interpretations, respectively (kappa score of 0.80). Although all qualitative variables of PVD are not consistently provided in echocardiogram reports, the inter-rater reliability of cardiologists evaluating measures of PVD revealed strong agreement, especially at 36 weeks PMA. We speculate that establishment of a protocol for echocardiographic evaluation may improve the identification of PVD in preterm infants.