title: Digital versus analogue pleural drainage phase 1: prospective evaluation of interobserver reliability in the assessment of pulmonary air leaks.
abstract: OBJECTIVE
  The ability to accurately characterize a pulmonary air leak is an essential skill in chest medicine and surgery. The objective was to evaluate interobserver variability in air leak assessments using analogue and digital pleural drainage systems.
  
  
  METHODS
  Air leak severity in lung resection patients with a pulmonary air leak was prospectively evaluated by at least one thoracic surgeon, one surgical resident and one to two nurses using a standardized questionnaire. The first assessment was performed with pleural drains connected to an analogue system. Subsequently, patients were re-assessed after changing from the analogue to a digital drainage system. The thoracic surgeon's evaluation was considered the reference standard for comparison. Agreement between observers was quantified using the kappa (κ) statistic.
  
  
  RESULTS
  A total of 128 air leak evaluations were completed in 30 patients (thoracic surgeon = 30; nurses = 56; resident = 30; physiotherapists = 12). The mean time between analogue and digital assessment was 2.16 (±1.66) h. The level of observer agreement regarding air leak severity significantly increased from very slight to substantial when using the digital drainage system [analogue κ = 0.03; confidence interval (CI): 0.04-0.11; P = 0.40) (digital κ = 0.61; CI: 0.49-0.73; P < 0.01]. Similar improvements were observed in subgroups of health-care professionals using digital technology.
  
  
  CONCLUSIONS
  Digital pleural drainage technology improves the agreement level between members of the health-care team when assessing the severity of a pulmonary air leak after lung resection.
authors.affiliation: The Division of Thoracic Surgery, University of British Columbia, Vancouver Coastal Health, Vancouver, Canada anna.mcguire@vch.ca.
authors.forename: Anna L
authors.initials: AL
authors.lastname: McGuire
authors.affiliation: The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Petrcich
authors.affiliation: The Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Canada.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Maziak
authors.affiliation: The Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Canada.
authors.forename: Farid M
authors.initials: FM
authors.lastname: Shamji
authors.affiliation: The Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Canada.
authors.forename: Sudhir R
authors.initials: SR
authors.lastname: Sundaresan
authors.affiliation: The Ottawa Hospital Research Institute (OHRI), Ottawa, Canada The Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Canada.
authors.forename: Andrew J E
authors.initials: AJ
authors.lastname: Seely
authors.affiliation: The Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Canada.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
mesh_terms: D000368:Aged; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D035422:Pleural Cavity; D011013:Pneumonectomy; D011030:Pneumothorax / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: Air leak; Chest tube; Lung surgery; Quality improvement