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Conducting Respiratory Oscillometry in an Outpatient Setting
Published on: April 8, 2022
Interobserver Reliability of the Respiratory Physical Examination in Premature Infants: A Multicenter Study
Erik A Jensen1, Howard Panitch2, Rui Feng3
1Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Insights
Physician agreement on respiratory exam findings in premature infants is low. However, predictions of respiratory illness were more accurate for infants on supplemental oxygen.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Clinical Assessment
Background:
- Premature infants born before 29 weeks' gestation often experience respiratory complications.
- Accurate assessment of respiratory physical examination findings is crucial for managing these vulnerable infants.
- Inter-rater reliability of these findings has not been well-established in this population.
Purpose of the Study:
- To evaluate the inter-rater reliability of specific respiratory physical examination findings in preterm infants.
- To assess physicians' ability to predict short-term respiratory morbidity in these infants.
Main Methods:
- A prospective, multicenter study involving standardized audio-video recordings of respiratory physical examinations.
- 32 physicians reviewed examinations of 30 infants born at 36-40 weeks' postmenstrual age.
- Physicians estimated the likelihood of prolonged hospitalization or readmission for respiratory illness.
Main Results:
- Inter-rater reliability varied significantly, with intraclass correlation values ranging from 0.73 for subcostal retractions to 0.22 for expiratory abdominal muscle use.
- Twenty-seven percent of infants were hospitalized or readmitted within 3 months.
- Physician prediction of respiratory morbidity was more accurate for infants receiving supplemental oxygen (AUC 0.90) than those on room air (AUC 0.71).
Conclusions:
- There is often a lack of physician agreement on respiratory physical examination findings in premature infants.
- Physician predictions of short-term respiratory outcomes are more reliable for infants requiring supplemental oxygen.
Objective:
To measure the inter-rater reliability of 7 visual and 3 auscultatory respiratory physical examination findings at 36-40 weeks' postmenstrual age in infants born less than 29 weeks' gestation. Physicians also estimated the probability that each infant would remain hospitalized for 3 months after the examination or be readmitted for a respiratory illness during that time.
Study Design:
Prospective, multicenter, inter-rater reliability study using standardized audio-video recordings of respiratory physical examinations.
Results:
We recorded the respiratory physical examination of 30 infants at 2 centers and invited 32 physicians from 9 centers to review the examinations. The intraclass correlation values for physician agreement ranged from 0.73 (95% CI 0.57-0.85) for subcostal retractions to 0.22 (95% CI 0.11-0.41) for expiratory abdominal muscle use. Eight (27%) infants remained hospitalized or were readmitted within 3 months after the examination. The area under the receiver operating characteristic curve for prediction of this outcome was 0.82 (95% CI 0.78-0.86). Physician predictive accuracy was greater for infants receiving supplemental oxygen (0.90, 95% CI 0.86-0.95) compared with those breathing in room air (0.71, 95% CI 0.66-0.75).
Conclusions:
Physicians often do not agree on respiratory physical examination findings in premature infants. Physician prediction of short-term respiratory morbidity was more accurate for infants receiving supplemental oxygen compared with those breathing in room air.
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