title: Neonatal Lung Sonography: Interobserver Agreement Between Physician Interpreters With Varying Levels of Experience.
abstract: OBJECTIVE
  To assess the reliability of lung sonography in neonates between physician interpreters with different degrees of experience.
  
  
  METHODS
  We retrospectively reviewed lung sonograms from neonates admitted to a neonatal intensive care unit with respiratory distress in the first 24 hours of life. The first scans were selected; only patients with available video clips documenting both hemithoraxes were included. The clips were independently examined by 4 different experienced observers blinded to clinical data. The interpreting physicians made a codified sonographic diagnosis, and the Cohen κ coefficient was used to measure the reliability between a proven experienced main interpreter and expert (κ1), intermediate (κ2), and beginner (κ3) control interpreters. We also calculated the specific agreement on respiratory distress syndrome and transient tachypnea of the neonate.
  
  
  RESULTS
  Four hundred sixty-five clips were taken from 114 neonates examined over a 16-month period. The patients' median gestational age (range) was 34 weeks (25-41 weeks), and the median birth weight (range) was 2085 g (608-4134 g). Eighty-eight percent of examinations were performed within 24 hours after birth. The overall κ coefficients (95% confidence intervals) were κ1 = 0.94 (0.88-1.00); κ2 = 0.72 (0.61-0.83); and κ3 = 0.81 (0.71-0.90). For respiratory distress syndrome, κ1 = 0.94 (0.87-1.00); κ2 = 0.90 (0.81-0.99); and κ3 = 0.87 (0.78-0.97). For transient tachypnea of the neonate, κ1 = 0.95 (0.89-1.00); κ2 = 0.76 (0.64-0.88); and κ3 = 0.81 (0.70-0.91).
  
  
  CONCLUSIONS
  In neonates with early respiratory distress, lung sonography has high interobserver agreement even between interpreters with varying levels of experience.
authors.affiliation: Department of Pediatrics, University of Udine School of Medicine, Udine, Italy (G.B., M.V., A.B.); Department of Neonatology, Santa Maria Della Misericordia Hospital, Udine, Italy (G.B., M.S., L.C.); and Emergency Department, Latisana General Hospital, Latisana, Italy (R.C.). giacomobrusa@libero.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Brusa
authors.affiliation: Department of Pediatrics, University of Udine School of Medicine, Udine, Italy (G.B., M.V., A.B.); Department of Neonatology, Santa Maria Della Misericordia Hospital, Udine, Italy (G.B., M.S., L.C.); and Emergency Department, Latisana General Hospital, Latisana, Italy (R.C.).
authors.forename: Marilena
authors.initials: M
authors.lastname: Savoia
authors.affiliation: Department of Pediatrics, University of Udine School of Medicine, Udine, Italy (G.B., M.V., A.B.); Department of Neonatology, Santa Maria Della Misericordia Hospital, Udine, Italy (G.B., M.S., L.C.); and Emergency Department, Latisana General Hospital, Latisana, Italy (R.C.).
authors.forename: Michela
authors.initials: M
authors.lastname: Vergine
authors.affiliation: Department of Pediatrics, University of Udine School of Medicine, Udine, Italy (G.B., M.V., A.B.); Department of Neonatology, Santa Maria Della Misericordia Hospital, Udine, Italy (G.B., M.S., L.C.); and Emergency Department, Latisana General Hospital, Latisana, Italy (R.C.).
authors.forename: Andrea
authors.initials: A
authors.lastname: Bon
authors.affiliation: Department of Pediatrics, University of Udine School of Medicine, Udine, Italy (G.B., M.V., A.B.); Department of Neonatology, Santa Maria Della Misericordia Hospital, Udine, Italy (G.B., M.S., L.C.); and Emergency Department, Latisana General Hospital, Latisana, Italy (R.C.).
authors.forename: Roberto
authors.initials: R
authors.lastname: Copetti
authors.affiliation: Department of Pediatrics, University of Udine School of Medicine, Udine, Italy (G.B., M.V., A.B.); Department of Neonatology, Santa Maria Della Misericordia Hospital, Udine, Italy (G.B., M.S., L.C.); and Emergency Department, Latisana General Hospital, Latisana, Italy (R.C.).
authors.forename: Luigi
authors.initials: L
authors.lastname: Cattarossi
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012127:Respiratory Distress Syndrome, Newborn / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014463:Ultrasonography / Q000706:statistics & numerical data*
keywords: interobserver agreement; lung sonography; neonate; pediatric ultrasound; respiratory distress syndrome; transient tachypnea of the neonate