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Agreement of an echocardiogram-based diagnosis of pulmonary hypertension in infants at risk for bronchopulmonary dysplasia among masked reviewers

Journal of Perinatology volume 39, pages 248–255 (2019)Cite this article

Subjects

Abstract

Objective

To evaluate the agreement of an echocardiogram-based pulmonary hypertension diagnosis in premature infants at risk for bronchopulmonary dysplasia (BPD).

Study design

Echocardiograms from infants born ≤28 weeks post menstrual age were retrospectively reviewed with a standardized reading protocol by three pediatric cardiologists masked to patient’s clinical history to determine the presence of pulmonary hypertension.

Results

A total of 483 echocardiograms from 49 unique patients were each reviewed by three pediatric cardiologists. Overall there was an 82.9% agreement on the presence of pulmonary hypertension among the three readers (95% CI: 78.4%, 85.4%) with a modified Fleiss’ kappa of 0.759 (95% CI: 0.711, 0.801). Percent agreement between rereads was 92.4%, and modified Fleiss’ kappa was 0.847 (95% CI: 0.750, 0.931).

Conclusions

Using a standardized reading protocol and echocardiogram-based definition of pulmonary hypertension, there is high inter- and intra-rater agreement for the diagnosis of pulmonary hypertension in at-risk premature infants, suggesting echocardiography can be successfully used for clinical and research monitoring of pulmonary hypertension in infants.

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Funding

This work was supported by the National Institutes of Health, NHLBI R34 HL124038. Dr. Laughon receives support from the US government for work in neonatal clinical pharmacology and clinical trials (FDA R01FD005101; PI Laughon, NHLBI R34 HL124038; PI Laughon, and Pediatric Trials Network Government Contract HHSN267200700051C; PI Benjamin Duke), for trial coordination (NIH OD 1UC2-OD023375; PI Smith); and as the satellite site PI for NICHD Neonatal Research Network (5U10HD040492; PI Cotton, Duke). Dr. Hornik receives salary support for research from National Institute for Child Health and Human Development (NICHD) (1K23HD090239) and the U.S. government for his work in pediatric and neonatal clinical pharmacology (Government Contract HHSN267200700051C, PI: Benjamin under the Best Pharmaceuticals for Children Act).

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    Andrew W. McCrary, Piers C. A. Barker, Rachel D. Torok, Jennifer S. Li & Christoph P. Hornik

  2. Duke Clinical Research Institute, Durham, NC, USA

    Rachel D. Torok, Tracy G. Spears, Jennifer S. Li & Christoph P. Hornik

  3. Department of Pediatrics Center for Predictive Medicine, Duke University Medical Center, Durham, NC, USA

    Tracy G. Spears

  4. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Matthew M. Laughon

Authors
  1. Andrew W. McCrary
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  2. Piers C. A. Barker
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  3. Rachel D. Torok
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Correspondence to Matthew M. Laughon.

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The authors declare that they have no conflict of interest.

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McCrary, A.W., Barker, P.C.A., Torok, R.D. et al. Agreement of an echocardiogram-based diagnosis of pulmonary hypertension in infants at risk for bronchopulmonary dysplasia among masked reviewers. J Perinatol 39, 248–255 (2019). https://doi.org/10.1038/s41372-018-0277-6

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