Angoulvant François, Llor Juan, Alberti Corinne, Kheniche Ahmed, Zaccaria Isabelle, Garel Catherine, Dauger Stéphane
Service de Réanimation et Surveillance Continue Pédiatriques, Hôpital Robert-Debré, Assistance Publique-Hôpitaux de Paris et Université Paris Diderot-Paris VII, Paris, France.
Pediatr Pulmonol. 2008 Oct;43(10):987-91. doi: 10.1002/ppul.20890.
Acute lung injury (ALI), including its most serious form called acute respiratory distress syndrome (ARDS), is a devastating disease that can occur at any age. ALI/ARDS accounts for only 5-8% of admissions to pediatric intensive care units (PICUs) but is fatal in 30-60% of cases. International multicenter prospective studies are needed to better understand pediatric ALI/ARDS. However, a reproducible definition of ALI/ARDS is crucial to ensure that study populations are homogeneous. We designed a retrospective review to test the inter-observer variability of chest radiograph interpretation for presence of the American-European Consensus Conference (AECC) radiographic criterion for ALI/ARDS. The medical files of 24 children ventilated for ALI/ARDS in our PICU between January 1993 and December 2002 were reviewed. Five pediatric radiologists and five pediatric intensivists interpreted one frontal chest radiograph (FCR) per patient taken on the day of ALI/ARDS diagnosis. Each reader indicated whether the radiograph showed the AECC radiographic criterion for ALI/ARDS. Data analysis involved comparing each reader to all the others based on the raw agreement and Kappa coefficient (kappa). Features in the 24 patients were consistent with earlier studies. Global inter-observer agreement beyond chance was fair (kappa = 0.29 +/- 0.02) among the five radiologists (kappa = 0.26 +/- 0.05) and among the five intensivists (kappa = 0.29 +/- 0.05). Thus, considerable inter-observer variability occurred in assessing the radiographic criterion for ALI/ARDS, as previously shown in adults. Given the low incidence of ALI/ARDS in children, this variability may have a large impact in studies of pediatric ALI/ARDS.
急性肺损伤（ALI），包括其最严重的形式即急性呼吸窘迫综合征（ARDS），是一种可发生于任何年龄的毁灭性疾病。ALI/ARDS在儿科重症监护病房（PICU）的入院病例中仅占5 - 8%，但在30 - 60%的病例中是致命的。需要开展国际多中心前瞻性研究以更好地了解儿童ALI/ARDS。然而，ALI/ARDS的可重复定义对于确保研究人群的同质性至关重要。我们设计了一项回顾性研究，以测试胸部X线片解读中观察者间对于ALI/ARDS的欧美共识会议（AECC）影像学标准存在情况的变异性。回顾了1993年1月至2002年12月期间在我们PICU因ALI/ARDS接受通气治疗的24名儿童的病历。五名儿科放射科医生和五名儿科重症监护医生对每名患者在ALI/ARDS诊断当天拍摄的一张胸部正位片（FCR）进行解读。每位阅片者指出该X线片是否显示了ALI/ARDS的AECC影像学标准。数据分析包括基于原始一致性和kappa系数（kappa）将每位阅片者与其他所有阅片者进行比较。24例患者的特征与早期研究一致。在五名放射科医生（kappa = 0.26 ± 0.05）和五名重症监护医生（kappa = 0.29 ± 0.05）中，观察者间总体一致性高于偶然水平，为中等（kappa = 0.29 ± 0.02）。因此，在评估ALI/ARDS的影像学标准时存在相当大的观察者间变异性，正如先前在成人中所显示的那样。鉴于儿童ALI/ARDS的发病率较低，这种变异性可能对儿童ALI/ARDS的研究产生重大影响。
