Bludevich Bryce M, Kauffman Jeremy D, Litz Cristen N, Farach Sandra M, DeRosa JoAnn C, Wharton Kristin, Potthast Kevin, Danielson Paul D, Snyder Christopher W, Chandler Nicole M
Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
J Pediatr Surg. 2020 Jun;55(6):1058-1064. doi: 10.1016/j.jpedsurg.2020.02.053. Epub 2020 Feb 27.
Cross-sectional imaging (CSI) may be clinically unnecessary in the evaluation of pectus excavatum (PE). The purpose of our study was to prospectively evaluate the accuracy and reliability of the modified percent depth (MPD), derived from caliper-based external measurements, in identifying PE.
Children 11-21 years old presenting for evaluation of PE or to obtain thoracic cross-sectional imaging for other indications were measured to derive the Modified Percent Depth. The Haller Index (HI) and Correction Index (CI) were calculated from CSI. Receiver-Operator Characteristic (ROC) analysis was used to compare the sensitivity and specificity of MPD, HI, and CI. Interrater reliability was assessed using Spearman's correlation coefficient and Cohen's Kappa coefficient.
Of 199 patients, 76 (38%) had severe PE. Median age was 16 years (range = 11-21). The median Modified Percent Depth was 21.4% (IQR = 16.2-26.3) among those with PE versus 4.1% (IQR = 1.7-6.4) in those without (p < 0.001). MPD ≥ 11% exhibited similar sensitivity and specificity to HI ≥ 3.25 and CI ≥ 10 for identifying PE (ROC 0.98 vs. 0.97 vs. 0.98, respectively, p = 0.41). With respect to interrater reliability, independent clinicians' caliper measurements exhibited 87% agreement when identifying MPD ≥ 11% (p < 0.001) with excellent correlation (Spearman's ρ > 0.71, p < 0.001).
Caliper-based, physical examination measurements of the Modified Percent Depth reliably identify pectus excavatum and represent an alternative to CSI-based measurements for the assessment of PE.
Diagnostic test.
Level II.
在漏斗胸（PE）评估中，横断面成像（CSI）在临床上可能并非必要。我们研究的目的是前瞻性评估基于卡尺的外部测量得出的改良深度百分比（MPD）在识别PE方面的准确性和可靠性。
对11至21岁因PE评估或因其他指征进行胸部横断面成像的儿童进行测量以得出改良深度百分比。从CSI计算哈勒指数（HI）和校正指数（CI）。采用受试者操作特征（ROC）分析比较MPD、HI和CI的敏感性和特异性。使用Spearman相关系数和Cohen卡帕系数评估评分者间信度。
199例患者中，76例（38%）患有重度PE。中位年龄为16岁（范围=11至21岁）。PE患者的中位改良深度百分比为21.4%（四分位间距=16.2至26.3），而无PE患者为4.1%（四分位间距=1.7至6.4）（p<0.001）。对于识别PE，MPD≥11%表现出与HI≥3.25和CI≥10相似的敏感性和特异性（ROC分别为0.98对0.97对0.98，p=·41）。关于评分者间信度，独立临床医生的卡尺测量在识别MPD≥11%时一致性为87%（p<0.001），相关性良好（Spearman's ρ>0.71，p<0.001）。
基于卡尺的体格检查测量改良深度百分比能够可靠地识别漏斗胸，是基于CSI测量评估PE的一种替代方法。
诊断试验。
二级。
