Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study

Purpose Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of...

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Published in:Intensive care medicine 2020-07, Vol.46 (7), p.1382-1393
Main Authors: López-Fernández, Yolanda M., Smith, Lincoln S., Kohne, Joseph G., Weinman, Jason P., Modesto-Alapont, Vicent, Reyes-Dominguez, Susana B., Medina, Alberto, Piñeres-Olave, Byron E., Mahieu, Natalie, Klein, Margaret J., Flori, Heidi R., Jouvet, Philippe, Khemani, Robinder G.
Format: Article
Language:English
Subjects:
Alveoli
Anesthesiology
Chest
Child
Children
Consolidation
Critical Care Medicine
Emergency Medicine
Epidemiology
Health aspects
Humans
Incidence
Injuries
Intensive
Intensive care
Lung diseases
Mechanical ventilation
Medical diagnosis
Medical imaging
Medical prognosis
Medicine
Medicine & Public Health
Mortality
Original
Pain Medicine
Pediatrics
Pneumology/Respiratory System
Prognosis
Prospective Studies
Quadrants
Radiographs
Radiography
Reliability analysis
Reproducibility of Results
Respiratory distress syndrome
Respiratory Distress Syndrome - diagnostic imaging
Respiratory therapy
Subgroups
United Kingdom
Ventilation
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Summary:Purpose Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO 2 /FiO 2 (PF) ratios (or SpO 2 /FiO 2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p  = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p  = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p  = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p  = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-020-06074-7