Ibirogba Eniola R, Novoa Y Novoa Victoria Arruga, Sutton Laura F, Neis Allan E, Marroquin Amber M, Coleman Tracey M, Praska Kathleen A, Freimund Tamara A, Ruka Krystal L, Warzala Vicki L, Sangi-Haghpeykar Haleh, Ruano Rodrigo
Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States.
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tenesse, United States.
J Clin Ultrasound. 2019 Nov;47(9):513-517. doi: 10.1002/jcu.22759. Epub 2019 Jul 16.
The purpose of this study was to evaluate the reproducibility of stomach position grading in congenital diaphragmatic hernia (CDH) as proposed by Cordier et al and Basta et al after standardization of the methods at our center.
We collected sonographic images from 23 fetuses with left-sided CDH at our center from 2010 to 2018. Nine operators (one maternal fetal medicine expert and eight sonographers) reviewed the selected images and graded the stomach position according to the methods of Cordier et al and Basta et al. We assessed the interoperator agreement with Fleiss's kappa statistics.
Overall agreement amongst all operators was moderate for both methods proposed by Cordier et al (k = 0.60, SE 0.07, 95% CI 0.47-0.73, P < .0001) and Basta et al (k = 0.60, SE 0.06, 95% CI 0.47-0.73, P < .0001). Interoperator agreement was moderate for grade 3 with the method by Cordier et al (k = 0.45, SE 0.09, 95% CI 0.27-0.64, P < .0001) and fair for grade 4 with the method by Basta et al (k = 0.33, SE 0.08, 95% CI 0.18-0.49 P < .0001).
Our study demonstrates a fair to moderate interoperator agreement of the stomach position grading methods proposed in the literature after standardization of the methods at our center. Further multicenter studies are needed to confirm our results.
本研究的目的是在我们中心对方法进行标准化后，评估Cordier等人和Basta等人提出的先天性膈疝（CDH）胃位置分级的可重复性。
我们收集了2010年至2018年在我们中心的23例左侧CDH胎儿的超声图像。九名操作人员（一名母胎医学专家和八名超声检查医师）查看了所选图像，并根据Cordier等人和Basta等人的方法对胃位置进行分级。我们用Fleiss卡方统计量评估了操作人员之间的一致性。
对于Cordier等人提出的两种方法（k = 0.60，标准误0.07，95%可信区间0.47 - 0.73，P <.0001）和Basta等人提出的方法（k = 0.60，标准误0.06，95%可信区间0.47 - 0.73，P <.0001），所有操作人员之间的总体一致性为中等。对于Cordier等人的方法，3级的操作人员间一致性为中等（k = 0.45，标准误0.09，95%可信区间0.27 - 0.64，P <.0001），对于Basta等人的方法，4级的一致性为一般（k = 0.33，标准误0.08，95%可信区间0.18 - 0.49，P <.0001）。
我们的研究表明，在我们中心对文献中提出的胃位置分级方法进行标准化后，操作人员之间的一致性为一般到中等。需要进一步的多中心研究来证实我们的结果。
