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Interrater Agreement of Physicians Identifying Lung Sliding Artifact on B-Mode And M-Mode Point of Care Ultrasound

Ross Prager1, Hans Clausdorff Fiedler2, Delaney Smith3

  • 1Division of Critical Care Medicine, Western University, London, ON, CAN.

POCUS Journal
|May 9, 2025
PubMed
Abstract

Insights

Physician agreement on lung sliding diagnosis using point-of-care ultrasound (POCUS) is only moderate. Accuracy was similar for B-mode and M-mode interpretations, highlighting a need for improved standardization in POCUS diagnostics.

Area of Science:

  • Medical Imaging
  • Diagnostic Ultrasound
  • Pulmonary Medicine

Background:

  • Chest point-of-care ultrasound (POCUS) is a primary tool for detecting lung sliding, crucial for diagnosing pneumothorax.
  • The interrater reliability of physicians interpreting lung sliding on POCUS remains largely unquantified.
  • The comparative diagnostic performance of B-mode versus M-mode ultrasound for lung sliding is unclear.

Purpose of the Study:

  • To evaluate the interrater reliability among physicians interpreting lung sliding on chest POCUS.
  • To compare the diagnostic performance of B-mode and M-mode ultrasound in identifying lung sliding.

Main Methods:

  • A cross-sectional study surveyed acute care physicians on their interpretation of 20 B-mode and M-mode POCUS clips.
  • A reference standard diagnosis was established by two experienced clinicians.
  • Interrater agreement was quantified using the intra-class correlation coefficient (ICC).

Main Results:

  • Twenty physicians participated, with 70% being residents; 70% reported high confidence in chest POCUS skills.
  • The ICC for B-mode interpretation was 0.44, and for M-mode interpretation was 0.43, indicating moderate agreement.
  • No significant differences in reliability were observed based on physician confidence or experience levels.

Conclusions:

  • Moderate interrater reliability exists among clinicians for diagnosing lung sliding via POCUS.
  • Physician accuracy in diagnosing lung sliding showed no significant difference between B-mode and M-mode interpretations in this study.
  • Further research and standardization may be needed to enhance the reliability of lung sliding detection in POCUS.
Keywords:
POCUSlung ultrasonographypneumothoraxpoint of care ultrasoundreliability

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