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Lung ultrasonography in pregnant women during the COVID-19 pandemic: an interobserver agreement study among obstetricians

Ultrasonography 2020년 39권 4호 p.340 ~ 349
Yassa Murat, Mutlu Memis Ali, Birol Pinar, Kuzan Taha Yusuf, Kalafat Erkan, Usta Canberk, Yavuz Emre, Keskin Ilkhan, Tug Niyazi,
소속 상세정보
 ( Yassa Murat ) - Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital Department of Obstetrics and Gynecology
 ( Mutlu Memis Ali ) - Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital Department of Obstetrics and Gynecology
 ( Birol Pinar ) - Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital Department of Obstetrics and Gynecology
 ( Kuzan Taha Yusuf ) - Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital Department of Radiology
 ( Kalafat Erkan ) - Middle East Technical University Faculty of Art and Science Department of Statistics
 ( Usta Canberk ) - Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital Department of Obstetrics and Gynecology
 ( Yavuz Emre ) - Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital Department of Obstetrics and Gynecology
 ( Keskin Ilkhan ) - Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital Department of Obstetrics and Gynecology
 ( Tug Niyazi ) - Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital Department of Obstetrics and Gynecology

Abstract


Purpose: This study investigated interobserver agreement in lung ultrasonography (LUS) in pregnant women performed by obstetricians with different levels of expertise, with confirmation by an expert radiologist.

Methods: This prospective study was conducted at a tertiary "Coronavirus Pandemic Hospital" in April 2020. Pregnant women suspected to have coronavirus disease 2019 (COVID-19) were included. Two blinded experienced obstetricians performed LUS on pregnant women separately and noted their scores for 14 lung zones. Following a theoretical and hands-on practical course, one experienced obstetrician, two novice obstetric residents, and an experienced radiologist blindly evaluated anonymized and randomized still images and videoclips retrospectively. Weighted Cohen's kappa and Krippendorff’s alpha tests were used to assess the interobserver agreement.

Results: Fifty-two pregnant women were included, with confirmed COVID-19 diagnosis rate of 82.7%. In total, 336 eligible still images and 115 videoclips were included in the final analysis. The overall weighted Cohen’s kappa values ranged from 0.706 to 0.912 for the 14 lung zones. There were only seven instances of major disagreement (>1 point) in the evaluation of 14 lung zones of 52 patients (n=728). The overall agreement between the radiologist and obstetricians for the still images (Krippendorff's α=0.856, 95% confidence interval [CI], 0.797 to 0.915) and videoclips (Krippendorff's α=0.785; 95% CI, 0.709 to 0.861) was good.

Conclusion: The interobserver agreement between obstetricians with different levels of experience on still images and videoclips of LUS was good. Following a brief theoretical course, obstetricians' performance of LUS in pregnant women and interpretation of pre-acquired LUS images can be considered consistent.

키워드

COVID-19; Interobserver variability; Lung ultrasound; Pregnancy; SARS-CoV-2

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