Agreement of an echocardiogram-based diagnosis of pulmonary hypertension in infants at risk for bronchopulmonary dysplasia among masked reviewers

• Published in: Journal of perinatology Vol. 39; no. 2; pp. 248 - 255
• Main Authors: McCrary, Andrew W., Barker, Piers C. A., Torok, Rachel D., Spears, Tracy G., Li, Jennifer S., Hornik, Christoph P., Laughon, Matthew M.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.02.2019; Nature Publishing Group
• Subjects: 692/53/2421; 692/699/75; Bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - diagnostic imaging; Cardiology; Diagnosis; Dysplasia; Echocardiography; Female; Humans; Hypertension; Hypertension, Pulmonary - diagnostic imaging; Infant; Infant, Newborn; Infant, Premature; Infants; Logistic Models; Lung diseases; Male; Medical diagnosis; Medicine; Medicine & Public Health; Menstruation; Pediatric cardiology; Pediatric Surgery; Pediatrics; Premature infants; Pulmonary hypertension; Respiratory therapy; Retrospective Studies; Risk; Risk Factors; Severity of Illness Index; Ultrasonic imaging
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-018-0277-6

Objective To evaluate the agreement of an echocardiogram-based pulmonary hypertension diagnosis in premature infants at risk for bronchopulmonary dysplasia (BPD). Study design Echocardiograms from infants born ≤28 weeks post menstrual age were retrospectively reviewed with a standardized reading protocol by three pediatric cardiologists masked to patient’s clinical history to determine the presence of pulmonary hypertension. Results A total of 483 echocardiograms from 49 unique patients were each reviewed by three pediatric cardiologists. Overall there was an 82.9% agreement on the presence of pulmonary hypertension among the three readers (95% CI: 78.4%, 85.4%) with a modified Fleiss’ kappa of 0.759 (95% CI: 0.711, 0.801). Percent agreement between rereads was 92.4%, and modified Fleiss’ kappa was 0.847 (95% CI: 0.750, 0.931). Conclusions Using a standardized reading protocol and echocardiogram-based definition of pulmonary hypertension, there is high inter- and intra-rater agreement for the diagnosis of pulmonary hypertension in at-risk premature infants, suggesting echocardiography can be successfully used for clinical and research monitoring of pulmonary hypertension in infants.