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

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.

Outcomes of universal SARS-CoV-2 testing program in pregnant women admitted to hospital and the adjuvant role of lung ultrasound in screening: a prospective cohort study

“…LUS steps forward with its simplicity and non-ionizing, rapid and portable nature [24]. The interobserver agreement between obstetricians with different levels of experience was found to be good [25]. The increasing prevalence of asymptomatic infected patients and decreasing the prevalence of symptomatic infections have raised the thoughts that universal testing possibly detects patients in a convalescent period or patients with subclinical active infection [18].…”

Utility of lung ultrasound assessment for probable SARS‐CoV‐2 infection during pregnancy and universal screening of asymptomatic individuals

“…Furthermore, use of imaging modalities is suggested for the preoperative screening of emergency cases 3 . Lung ultrasound (LUS) is an ionizing‐radiation‐free, reproducible imaging modality for evaluating lung lesions, and its results are readily available, well in advance of the RT‐PCR results 4 . However, the added benefit of LUS for managing symptomatic and asymptomatic patients with SARS‐CoV‐2 infection during pregnancy remains unclear.…”

“…Posterior, basal and lateral portions of the maternal lungs were examined and videoclips were stored for offline evaluation. The obstetricians performing the examinations received a brief training course on LUS and saved images were subject to quality control measures 4 . Two researchers (E.K., M.Y), who were blinded to the RT‐PCR results of the patients, evaluated and scored the anonymized videoclips.…”

New Insight into Laboratory Tests and Imaging Modalities for Fast and Accurate Diagnosis of COVID-19: Alternative Suggestions for Routine RT-PCR and CT—A Literature Review

“…Lung ultrasound in pregnant women is easy to perform and effective in assessing lung involvement [ 51 ]. Anecdotal evidence suggests that lung involvement in pregnant women is readily seen with lung ultrasound and can influence the clinical management of pregnant women with COVID-19 [ 52 – 54 ].…”