Interobserver reliability and accuracy of cranial ultrasound scanning interpretation in premature infants.
OBJECTIVE
To assess interobserver reliability between 2 central readers of cranial ultrasound scanning (CUS) and accuracy of local, compared with central, interpretations.


METHODS
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.


RESULTS
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%).


CONCLUSIONS
Our findings demonstrate reliability and accuracy of highly unfavorable CUS findings, but suggest caution when interpreting mild to moderate IVH or white matter injury.
Hintz
Susan R
SR
Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA. srhintz@stanford.edu
Slovis
Thomas
T
Bulas
Dorothy
D
Van Meurs
Krisa P
KP
Perritt
Rebecca
R
Stevenson
David K
DK
Poole
W Kenneth
WK
Das
Abhik
A
Higgins
Rosemary D
RD
D001993:Bronchodilator Agents; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D004108:Dilatation, Pathologic / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000000981:diagnostic imaging* / Q000473:pathology; D009569:Nitric Oxide / Q000627:therapeutic use; D015588:Observer Variation; D011237:Predictive Value of Tests; D012131:Respiratory Insufficiency / Q000188:drug therapy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D001993:Bronchodilator Agents; D009569:Nitric Oxide