Tsung James W, Firnberg Maytal, Sosa Philip
Departments of Pediatrics and Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ultrasound J. 2024 Aug 6;16(1):38. doi: 10.1186/s13089-024-00386-1.
Educational video datasets can be an effective method for training in emergency department (ED) point-of-care ultrasound (PoCUS). A video dataset for normal appendix and appendicitis in children using ED PoCUS images was developed to assess interobserver agreement, as measured by Cohen's Kappa on key sonographic findings.
Three sets of 25 ED PoCUS videos were selected and curated from pediatric patients with normal appendix and acute appendicitis. Four participant ED sonologist-physicians were trained on the first set of 25 videos showing normal appendix or normal bowel in patients without appendicitis to note if normal appendix was seen in any part or in it's entirety from tip-to-cecum. They were then tested on the second set of similar videos. A third set of 25 videos from patients who had appendicitis where participant sonologists were asked to note if appendicitis was present or absent, with and without appendicolith or perforation. Cohen's Kappa was calculated in aggregate and stratified by experience vs. novice against a senior sonologist-physician aware of all patient outcomes for visualization of: 1. any part of normal appendix, 2. normal appendix visualized from tip to cecum 3. any part of appendicitis, 4. appendicolith, 5. appendiceal perforation.
Cohen's Kappa for any part of normal appendix, 0.71, 95% CI (0.58-0.85); normal appendix tip-to-cecum, 0.43, 95% CI (0.19-0.67), appendicitis, 0.53, 95%CI (0.34-0.70), appendicolith, 0.63, 95%CI (0.43-0.84), perforated appendicitis, 0.46, 95%CI (0.22-0.70). Stratified by experienced vs. novice: any part of normal appendix, 0.75 vs. 0.68; normal appendix tip-to-cecum, 0.50 vs. 0.36; appendicitis, 0.78 vs. 0.31; appendicolith, 0.75 vs. 0.5; perforated appendicitis, 0.5 vs 0.42.
This educational video dataset may be used to train sonologist-physicians in ED PoCUS scanning for normal appendix and appendicitis in children. Sonologist experience affected interobserver agreement with respect to visualization of entire normal appendix and appendicitis.
教育视频数据集可能是急诊科（ED）床旁超声检查（PoCUS）培训的有效方法。利用ED PoCUS图像开发了一个关于儿童正常阑尾和阑尾炎的视频数据集，以评估观察者间的一致性，通过对关键超声检查结果计算科恩kappa系数来衡量。
从患有正常阑尾和急性阑尾炎的儿科患者中选择并整理了三组25个ED PoCUS视频。四名参与的急诊超声科医生在第一组25个视频上接受培训，这些视频展示了无阑尾炎患者的正常阑尾或正常肠管，以记录是否在任何部位或从尖端到盲肠的整个部位看到正常阑尾。然后他们在第二组类似的视频上进行测试。第三组25个视频来自患有阑尾炎的患者，要求参与的超声科医生记录是否存在阑尾炎，有无阑尾结石或穿孔。科恩kappa系数是综合计算的，并按经验丰富与新手分层，与一名了解所有患者结局的资深超声科医生进行比较，以观察：1. 正常阑尾的任何部位，2. 从尖端到盲肠可视化的正常阑尾，3. 阑尾炎的任何部位，4. 阑尾结石，5. 阑尾穿孔。
正常阑尾任何部位的科恩kappa系数为0.71，95%可信区间（0.58 - 0.85）；正常阑尾从尖端到盲肠的科恩kappa系数为0.43，95%可信区间（0.19 - 0.67），阑尾炎的科恩kappa系数为0.53，95%可信区间（0.34 - 0.70），阑尾结石的科恩kappa系数为0.63，95%可信区间（0.43 - 0.84），穿孔性阑尾炎的科恩kappa系数为0.46，95%可信区间（0.22 - 0.70）。按经验丰富与新手分层：正常阑尾任何部位为0.75对0.68；正常阑尾从尖端到盲肠为0.50对0.36；阑尾炎为0.78对0.31；阑尾结石为0.75对0.5；穿孔性阑尾炎为0.5对0.42。
这个教育视频数据集可用于培训超声科医生在ED中对儿童正常阑尾和阑尾炎进行PoCUS扫描。超声科医生的经验影响了在可视化整个正常阑尾和阑尾炎方面的观察者间一致性。
