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International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Reliability of CXR for the diagnosis of bronchopulmonary dysplasia
M P Moya1, G S Bisset, R L Auten
1Duke University Medical Center, Department of Pediatrics, Division of Neonatology, 204 Bell Bldg., DUMC 3179, Durham 27710, NC, USA. moya0001@mc.duke.edu
Insights
Chest radiography for diagnosing bronchopulmonary dysplasia (BPD) lacks observer reliability, especially in early stages. The Weinstein score shows potential only at disease extremes, hindering objective BPD assessment.
Area of Science:
- Neonatology
- Pediatric Radiology
- Pulmonary Medicine
Background:
- Bronchopulmonary dysplasia (BPD) remains a significant concern in neonatology, particularly with increased survival rates of premature infants.
- Lack of standardized diagnostic criteria impedes research into new BPD treatments.
- Objective assessment tools, such as radiographic scoring systems, are crucial for evaluating lung injury and chronic lung disease risk.
Purpose of the Study:
- To evaluate the inter-observer reliability of a recently developed chest radiography scoring system for diagnosing BPD.
- To determine if the Weinstein score can provide objective and consistent BPD diagnosis.
Main Methods:
- One hundred chest radiographs were analyzed: 50 with BPD and 50 without.
- Pediatric radiologists and a neonatologist applied the Weinstein score (1-6) to assess radiographic severity.
- Inter-observer reliability was quantified using kappa (k) statistics.
Main Results:
- The reliability of the Weinstein scoring system was unacceptably low at the lowest threshold (score 1 vs. >=2).
- Improved reliability was observed when comparing broader score ranges (1-3 vs. 4-6).
Conclusions:
- Chest radiography, using the Weinstein score, demonstrates poor inter-observer reliability for BPD diagnosis across most disease severities.
- The scoring system may only be reliable for differentiating between the mildest and most severe forms of BPD.
Background:
Bronchopulmonary dysplasia (BPD) continues to be prevalent, despite new treatment, in part because of increased survival in less mature infants. Investigations of new treatments have been hampered by a lack of universally accepted diagnostic criteria. Radiographic scoring systems have been developed to provide objective assessment of lung injury and risk for chronic lung disease.
Objective:
We sought to test the reliability of a recently reported system using chest radiography as the main tool for diagnosis of BPD.
Materials And Methods:
One hundred chest radiographs, half demonstrating BPD and the other half without BPD, were analyzed by pediatric radiologists and by a neonatologist, using the Weinstein score (1-6, depending on increasing radiographic severity). The reliability of this scoring system was tested by kappa (k) statistics.
Results:
Reliability at the lowest threshold (dividing score 1 from score > or = 2) was unacceptably low in this population. Reliability increased with inclusion of higher BPD scores in the comparison groups: 1-3 versus 4-6.
Conclusion:
Using the chest radiograph for the prediction of BPD is not reliable between different observers except at the two extremes of the disease.
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