Inter-rater agreement in the evaluation of abdominal radiographs for necrotizing enterocolitis

Elkady, Sherif; Petel, Dara; Baird, Robert

doi:10.1016/j.jpedsurg.2014.02.058

Cited by 11 publications

(9 citation statements)

References 27 publications

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“…Lack of validity of the NEC diagnosis might partly be explained by poor inter-rater agreement between radiologists regarding the presence of intestinal pneumatosis (17), which is the radiologic sign used to distinguish between Bell's stages one and two (4). Conversely, others found that attending radiologists showed an excellent inter-rater agreement when looking at radiographs from infants with Bell's stages 1-3 (18), and the problem in our cohort was not solely distinguishing between stages one and two of NEC. Nevertheless, increasing the routine use of abdominal ultrasound may increase the validity of NEC diagnoses in the future (19).…”

Section: Discussioncontrasting

confidence: 67%

Poor validity of the routine diagnosis of necrotising enterocolitis in preterm infants at discharge

et al. 2016

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Section: Discussioncontrasting

confidence: 67%

Poor validity of the routine diagnosis of necrotising enterocolitis in preterm infants at discharge

et al. 2016

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“…The most recent study by El-Kady et al [ 27 ] confirmed that there are differences in the inter-observer agreement between radiologists, pediatric surgeons, and trainees. The results of their study are similar to the ones obtained by us ( κ w values ranging from 0.51 to 0.87).…”

Section: Discussionmentioning

confidence: 99%

Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS)

et al. 2016

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PurposeNecrotizing enterocolitis (NEC) is associated with high morbidity and mortality. Abdominal radiography is currently an imaging modality of choice in NEC. Recently, a numeric scale of radiological signs in NEC—The Duke Abdominal Assessment (DAAS) was introduced. The aim of this study was to measure the intra- and inter-observer agreement on the radiological signs of NEC according to DAAS to access the feasibility of this scale.Materials and methodsWe have retrospectively analyzed 87 radiographs performed in a group of 43 high-risk neonates with suspected NEC. Radiographs were assessed by 6 independent observers: two pediatric radiologists, two radiology residents, and two neonatologists. Data were analyzed using κ statistics as a measure of intra- and inter-observer agreement.ResultsFair-to-good intra-observer agreement was noted for all but one of observers. However, with the wide range in κ values, we found only fair inter-observer agreement detecting signs of NEC according to DAAS. There was a higher intra-group agreement in radiology practitioners, with the highest among experienced pediatric radiologists.ConclusionHowever, with high observer variability in interpretation of all radiologic signs, we did not confirm that Duke Abdominal Assessment Scale could reliable facilitate reporting of abdominal radiographic findings in neonates with suspected NEC.Electronic supplementary materialThe online version of this article (doi:10.1007/s00383-016-4022-y) contains supplementary material, which is available to authorized users.

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“…AR interpretation is very difficult and AR suffers from worse interexpert variability compared with AUS. There is also a significant overlap of radiographic findings between NEC and other ANIDs 17 29 59–63. It is difficult to distinguish NEC from SIP as intestinal gas patterns are non-specific and small amounts of ascites (present in the early NEC) are very hard to see on radiograph 27 35.…”

Section: Differential Clinical and Imaging Findingsmentioning

confidence: 99%

Abdominal ultrasound should become part of standard care for early diagnosis and management of necrotising enterocolitis: a narrative review

Druten

Khashu

Chan

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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Necrotising enterocolitis (NEC) is a leading cause of death and disability in preterm newborns. Early diagnosis through non-invasive investigations is a crucial strategy that can significantly improve outcomes. Hence, this review gives particular attention to the emerging role of abdominal ultrasound (AUS) in the early diagnosis of NEC, its performance against abdominal radiograph and the benefits of AUS use in daily practice. AUS has been used in the diagnosis and management of NEC for a couple of decades. However, its first-line use has been minimal, despite growing evidence demonstrating AUS can be a critical tool in the early diagnosis and management of NEC. In 2018, the NEC group of the International Neonatal Consortium recommended using AUS to detect pneumatosis and/or portal air in preterm NEC as part of the ‘Two out of three’ model. To facilitate widespread adoption, and future improvement in practice and outcomes, collaboration between neonatologists, surgeons and radiologists is needed to generate standard operating procedures and indications for use for AUS. The pace and scale of the benefit generated by use of AUS can be amplified through use of computer-aided detection and artificial intelligence.

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Inter-rater agreement in the evaluation of abdominal radiographs for necrotizing enterocolitis

Cited by 11 publications

References 27 publications

Poor validity of the routine diagnosis of necrotising enterocolitis in preterm infants at discharge

Poor validity of the routine diagnosis of necrotising enterocolitis in preterm infants at discharge

Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS)

Abdominal ultrasound should become part of standard care for early diagnosis and management of necrotising enterocolitis: a narrative review

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