Critical Care and Shock

Ultrasound cardiac output monitor inter-rater agreement in Pediatric Intensive Care Unit

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Abstract

Objective: Although Ultrasound Cardiac Output Measurement (USCOM) is relatively simple to operate, its reliability for novice user needs to be assessed. This study aims to determine inter-rater agreement of USCOM between pediatric residents as novices and pediatric intensivist as experienced operator.

Design: An observational study.

Setting: A single-center study in Pediatric Intensive Care Unit.

Patients and participants: Pediatric residents underwent in-house training and 20 practice scans, followed by blinded trans-aortic USCOM cardiac index (CI) measurements made by one of two randomly selected pediatric residents paired with one pediatric intensivist. CI, its categorization and image quality, were noted.

Measurements and results: Paired measurements were performed on 48 subjects. Median of subjects age were 2 years (1 month to less than 18-year-old). Spearman’s rank showed strong positive correlation of CI (rs=0.77; 95% CI=0.62-0.86). Inter-rater agreement by Cohen’s kappa showed substantial agreement on CI (ĸ=0.78).

Conclusion: Following training, pediatric residents were able to measure CI using USCOM with substantial inter-rater agreement.