Prager Ross, Fiedler Hans Clausdorff, Smith Delaney, Wu Derek, Arntfield Robert
Division of Critical Care Medicine, Western University, London, ON, CAN.
Sección de Medicina de Urgencia. Pontificia Universidad Católica de Chile, CHL.
POCUS J. 2025 Apr 15;10(1):92-98. doi: 10.24908/pocusj.v10i01.17807. eCollection 2025 Apr.
Chest point of care ultrasound (POCUS) is a first-line diagnostic test to identify lung sliding, an important artifact to diagnose or rule out pneumothorax. Despite enthusiastic adoption of this modality, the interrater reliability for physicians to identify lung sliding is unknown. Additionally, the relative diagnostic performance of physicians interpreting B-mode and M-mode ultrasound is unclear. We sought to determine the interrater reliability of physicians to detect lung sliding on B-mode and M-mode POCUS.
We performed a cross-sectional interrater agreement study surveying acute care physicians on their interpretation of 20 B-mode and M-mode POCUS clips. Two experienced clinicians determined the reference standard diagnosis. Respondents reported their interpretation of each POCUS B-mode clip or M-mode image. The primary outcome was the interrater agreement, determined by an intra-class correlation coefficient (ICC).
From September to November 2023, there were 20 survey respondents. Fourteen (70%) respondents were resident physicians. Respondents were confident or very confident in their skill performing chest POCUS in 14 (70%) cases, with 19 (90%) performing chest POCUS every week or more frequently. The ICC on B-mode was 0.44 and for M-mode was 0.43, indicating moderate agreement. There were no significant differences in interrater reliability between subgroups of confidence or experience.
There is only moderate interrater reliability between clinicians to diagnose lung sliding. Clinicians have superior accuracy on B-mode compared to M-mode clips.
床旁胸部超声（POCUS）是识别肺滑动的一线诊断测试，肺滑动是诊断或排除气胸的重要伪像。尽管这种检查方式被广泛采用，但医生识别肺滑动的评分者间可靠性尚不清楚。此外，医生解读B模式和M模式超声的相对诊断性能也不明确。我们试图确定医生在B模式和M模式POCUS上检测肺滑动的评分者间可靠性。
我们进行了一项横断面评分者间一致性研究，调查急性护理医生对20个B模式和M模式POCUS片段的解读。两名经验丰富的临床医生确定参考标准诊断。受访者报告他们对每个POCUS B模式片段或M模式图像的解读。主要结果是评分者间一致性，由组内相关系数（ICC）确定。
2023年9月至11月，有20名受访者。14名（70%）受访者是住院医生。14名（70%）受访者对自己进行胸部POCUS的技能有信心或非常有信心，19名（90%）受访者每周或更频繁地进行胸部POCUS。B模式的ICC为0.44，M模式的ICC为0.43，表明一致性中等。信心或经验亚组之间的评分者间可靠性没有显著差异。
临床医生之间诊断肺滑动的评分者间可靠性仅为中等。与M模式片段相比，临床医生在B模式上的准确性更高。
