title: Intra- and inter-observer reliability using a noninvasive ultrasound cardiac output monitor in healthy anesthetized children.
abstract: BACKGROUND
  Accurate and reliable evaluation of cardiac index (CI) in critically ill pediatric patients can optimize their management. Although validated, noninvasive ultrasound measurement techniques have been previously shown to be unreliable because of observer variability.
  
  
  OBJECTIVE
  To confirm intra- and inter-observer reliability when using the noninvasive USCOM(®) in healthy anesthetized children.
  
  
  METHODS
  Prospective observational study at the Children's Hospital of Eastern Ontario, Ottawa, included newborns to 12 years of age undergoing elective surgery or magnetic resonance imaging. The USCOM(®) was used to assess CI via aortic flow with a trans-sternal approach. Two trained observers were responsible for taking two measurements of CI each at steady state in randomized succession after stable depth of anesthesia was achieved.
  
  
  RESULTS
  Fifty-nine patients were included. Forty-seven (80%) were between 3 and 7 years old, with 57% male. The mean difference ± sd for repeat CI measurements by each of two observers was 0.11 ± 0.47 and 0.05 ± 0.65 l·min(-1) ·m(-2) , respectively. Intra-observer reliability for these repeat measurements by each observer determined by Lin's concordance correlation coefficient was 0.92 and 0.85, respectively. The mean difference ± sd between observers was 0.16 ± 0.59 l·min(-1) ·m(-2) , and Lin's concordance correlation coefficient was 0.87. The two observers subjectively rated measurements as 'Difficult' or 'Very difficult' only 14% (16/118) and 3% (4/118) of the time, respectively. No adverse events were reported.
  
  
  CONCLUSIONS
  This study confirms that the USCOM(®) is relatively easy to use and reliable in healthy children when operated by trained users.
authors.affiliation: Department of Pediatric Critical Care, Children's Hospital of Eastern Ontario, ON, Canada. sdhanani@cheo.on.ca
authors.forename: Sonny
authors.initials: S
authors.lastname: Dhanani
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Barrowman
authors.forename: Roxanne E
authors.initials: RE
authors.lastname: Ward
authors.forename: Kimmo T
authors.initials: KT
authors.lastname: Murto
mesh_terms: D000758:Anesthesia; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D015331:Cohort Studies; D004452:Echocardiography / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008738:Methyl Ethers; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods*; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D000077149:Sevoflurane; D013815:Thermodilution / Q000379:methods
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane