Chest radiograph scores in preterm infants: interobserver agreement and relation to respiratory function

To evaluate scoring systems for chest radiographs, we determined interobserver agreement and relation to the lung function during the 1st week of life in ventilated preterm infants. Three independent observers examined chest radiographs by applying radiological scores according to Lischka, Yuksel, Greenough, Toce, and Giedion on postnatal days 2 and 7. Kappa statistics was used to assess the interobserver agreement. By means of regression analysis, mean scores and individual radiological scores of the three observers were studied in relation to ventilation and oxygenation indices and respiratory system resistance and compliance. Forty-eight radiographs were evaluated on day 2 and 17 radiographs on day 7. All scoring systems showed kappa values equal to or <0.5. Regression analysis revealed no significant associations between radiological scores and ventilator requirements or respiratory mechanics. We conclude that in ventilated preterm infants radiological scoring systems showed a poor interobserver agreement and that they were not related to the actual respiratory function.