PDF(Pubmed)
Abstract：
Diagnostic guidelines for pediatric ARDS (PARDS) were developed at the 2015 Pediatric Acute Lung Injury Consensus Conference (PALICC). Although this was an improvement in creating pediatric-specific diagnostic criteria, there remains potential for variability in identification of PARDS.
What is the interrater reliability of the 2015 PALICC criteria for diagnosing moderate to severe PARDS? What clinical criteria and patient factors are associated with diagnostic disagreements?
Patients with acute hypoxic respiratory failure admitted from 2016 to 2021 who received invasive mechanical ventilation were retrospectively reviewed by two pediatric ICU physicians. Reviewers evaluated whether the patient met the 2015 PALICC definition of moderate to severe PARDS and rated their diagnostic confidence. Interrater reliability was measured using Gwet\'s agreement coefficient.
Thirty-seven of 191 encounters had a diagnostic disagreement. Interrater reliability was substantial (Gwet\'s agreement coefficient, 0.74; 95% CI, 0.65-0.83). Disagreements were caused by different interpretations of chest radiographs (56.8%), ambiguity in origin of pulmonary edema (37.8%), or lack of clarity if patient\'s current condition was significantly different from baseline (27.0%). Disagreement was more likely in patients who were chronically ventilated (OR, 4.66; 95% CI, 2.16-10.08; P < .001), had a primary cardiac admission diagnosis (OR, 3.36; 95% CI, 1.18-9.53; P = .02), or underwent cardiothoracic surgery during the admission (OR, 4.90; 95% CI, 1.60-15.00; P = .005). Reviewers were at least moderately confident in their decision 73% of the time; however, they were less likely to be confident if the patient had cardiac disease or chronic respiratory failure.
The interrater reliability of the 2015 PALICC criteria for diagnosing moderate to severe PARDS in this cohort was substantial, with diagnostic disagreements commonly caused by differences in chest radiograph interpretations. Patients with cardiac disease or chronic respiratory failure were more vulnerable to diagnostic disagreements. More guidance is needed on interpreting chest radiographs and diagnosing PARDS in these subgroups.
What is the interrater reliability of the 2015 PALICC criteria for diagnosing moderate to severe PARDS? What clinical criteria and patient factors are associated with diagnostic disagreements?
Patients with acute hypoxic respiratory failure admitted from 2016 to 2021 who received invasive mechanical ventilation were retrospectively reviewed by two pediatric ICU physicians. Reviewers evaluated whether the patient met the 2015 PALICC definition of moderate to severe PARDS and rated their diagnostic confidence. Interrater reliability was measured using Gwet\'s agreement coefficient.
Thirty-seven of 191 encounters had a diagnostic disagreement. Interrater reliability was substantial (Gwet\'s agreement coefficient, 0.74; 95% CI, 0.65-0.83). Disagreements were caused by different interpretations of chest radiographs (56.8%), ambiguity in origin of pulmonary edema (37.8%), or lack of clarity if patient\'s current condition was significantly different from baseline (27.0%). Disagreement was more likely in patients who were chronically ventilated (OR, 4.66; 95% CI, 2.16-10.08; P < .001), had a primary cardiac admission diagnosis (OR, 3.36; 95% CI, 1.18-9.53; P = .02), or underwent cardiothoracic surgery during the admission (OR, 4.90; 95% CI, 1.60-15.00; P = .005). Reviewers were at least moderately confident in their decision 73% of the time; however, they were less likely to be confident if the patient had cardiac disease or chronic respiratory failure.
The interrater reliability of the 2015 PALICC criteria for diagnosing moderate to severe PARDS in this cohort was substantial, with diagnostic disagreements commonly caused by differences in chest radiograph interpretations. Patients with cardiac disease or chronic respiratory failure were more vulnerable to diagnostic disagreements. More guidance is needed on interpreting chest radiographs and diagnosing PARDS in these subgroups.
摘要：
背景：儿童急性呼吸窘迫综合征（PARDS）的诊断指南是在2015年儿童急性肺损伤共识会议（PALICC）上制定的。尽管这是在创建儿科特定诊断标准方面的改进，PARDS的鉴定仍存在差异的可能性。
目的：2015年PALICC标准诊断中重度PARDS的评估者间可靠性如何？哪些临床标准和患者因素与诊断分歧相关？
方法：两名PICU医师对2016-2021年收治的急性低氧性呼吸衰竭患者进行了回顾性分析。审稿人评估患者是否符合2015年PALICC中重度PARDS定义，并对其诊断置信度进行评级。使用Gwet协议系数(AC1)测量评估者间的可靠性。
结果：191次相遇中有37次存在诊断分歧。评估者间可靠性为“实质性”(AC1=0.74，95%CI[0.65-0.83])。分歧是由于胸部X光片的不同解释(56.8%),肺水肿的起源不明确（37.8%），如果患者目前的状况与基线有显著差异（27.0%），或缺乏清晰度。长期通气的患者更有可能出现分歧(OR4.66,95%CI[2.16-10.08],p<0.001)，有原发性心脏入院诊断(OR3.36，95%CI[1.18-9.53]，p=0.02),或在入院期间接受了心胸外科手术(OR4.90,95%CI[1.60-15.00],p=0.005)。在73%的情况下，审稿人对他们的决定至少有适度的信心，然而，如果患者患有心脏病或慢性呼吸衰竭，则不太可能自信。
结论：在该队列中，2015年PALICC诊断中重度PARDS标准的评分者间可靠性很高，诊断分歧通常是由于胸部X光片解释的差异。患有心脏病或慢性呼吸衰竭的患者更容易出现诊断分歧。在解释这些亚组的胸部X光片和诊断PARDS方面需要更多的指导。
目的：2015年PALICC标准诊断中重度PARDS的评估者间可靠性如何？哪些临床标准和患者因素与诊断分歧相关？
方法：两名PICU医师对2016-2021年收治的急性低氧性呼吸衰竭患者进行了回顾性分析。审稿人评估患者是否符合2015年PALICC中重度PARDS定义，并对其诊断置信度进行评级。使用Gwet协议系数(AC1)测量评估者间的可靠性。
结果：191次相遇中有37次存在诊断分歧。评估者间可靠性为“实质性”(AC1=0.74，95%CI[0.65-0.83])。分歧是由于胸部X光片的不同解释(56.8%),肺水肿的起源不明确（37.8%），如果患者目前的状况与基线有显著差异（27.0%），或缺乏清晰度。长期通气的患者更有可能出现分歧(OR4.66,95%CI[2.16-10.08],p<0.001)，有原发性心脏入院诊断(OR3.36，95%CI[1.18-9.53]，p=0.02),或在入院期间接受了心胸外科手术(OR4.90,95%CI[1.60-15.00],p=0.005)。在73%的情况下，审稿人对他们的决定至少有适度的信心，然而，如果患者患有心脏病或慢性呼吸衰竭，则不太可能自信。
结论：在该队列中，2015年PALICC诊断中重度PARDS标准的评分者间可靠性很高，诊断分歧通常是由于胸部X光片解释的差异。患有心脏病或慢性呼吸衰竭的患者更容易出现诊断分歧。在解释这些亚组的胸部X光片和诊断PARDS方面需要更多的指导。
