Interobserver reliability and accuracy of cranial ultrasound scanning interpretation in premature infants

Objective To assess interobserver reliability between 2 central readers of cranial ultrasound scanning (CUS) and accuracy of local, compared with central, interpretations. Study design The study was a retrospective analysis of CUS data from the National Institute of Child Health and Human Development (NICHD) trial of inhaled nitric oxide for premature infants. Initerobserver reliability of 2 central readers was assessed with kappa or weighted kappa. Accuracy of local, compared with central, interpretations was assessed by rising sensitivity and specificity. Results CUS from 326 infants had both central reader and local interpretations. Central reader agreement for grade 3/4 intraventricular hemorrhage (IVH), grade 3/4 IVH or periventricular leukomalacia (PVL,), grade of IVH, and degree of ventriculomegaly was very good (kappa = 0.84, 0.81, 0.79, and 0.75, respectively). Agreement was poor for lower grade lVH and for PVL alone. Local interpretations were highly accurate for grade 3/4 lVH or PVL, (sensitivity, 87%-90% specificity, 92%-93(Yo), but sensitivity was poor-to-fair for grade 1/2 IVH (48%-68%) and PVL (20%-44%). Conclusions Our findings demonstrate reliability and accuracy of highly unfavorable CUS findings, but suggest caution when interpreting mild to moderate IVH or white matter injury.