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Standardization of Sonographic Lung‐to‐Head Ratio Measurements in Isolated Congenital Diaphragmatic Hernia
Author(s) -
Britto Ingrid Schwach Werneck,
Sananes Nicolas,
Olutoye Oluyinka O.,
Cass Darrell L.,
Sangi-Haghpeykar Haleh,
Lee Timothy C.,
Cassady Christopher I.,
Mehollin-Ray Amy,
Welty Stephen,
Fernandes Caraciolo,
Belfort Michael A.,
Lee Wesley,
Ruano Rodrigo
Publication year - 2015
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.15.14.11064
Subject(s) - medicine , intraclass correlation , reproducibility , congenital diaphragmatic hernia , confidence interval , extracorporeal membrane oxygenation , receiver operating characteristic , diaphragmatic hernia , standardization , lung , nuclear medicine , diaphragmatic breathing , radiology , surgery , hernia , pathology , pregnancy , clinical psychology , fetus , statistics , alternative medicine , mathematics , biology , political science , genetics , psychometrics , law
Objectives The purpose of this study was to evaluate the impact of standardization of the lung‐to‐head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility. Methods We conducted a retrospective cohort study of 77 cases of isolated congenital diaphragmatic hernia managed in a single center between 2004 and 2012. We compared lung‐to‐head ratio measurements that were performed prospectively in our institution without standardization to standardized measurements performed according to a defined protocol. Results The standardized lung‐to‐head ratio measurements were statistically more accurate than the nonstandardized measurements for predicting neonatal mortality (area under the receiver operating characteristic curve, 0.85 versus 0.732; P = .003). After standardization, there were no statistical differences in accuracy between measurements regardless of whether we considered observed‐to‐expected values ( P > .05). Standardization of the lung‐to‐head ratio did not improve prediction of the need for extracorporeal membrane oxygenation ( P > .05). Both intraoperator and interoperator reproducibility were good for the standardized lung‐to‐head ratio (intraclass correlation coefficient, 0.98 [95% confidence interval, 0.97–0.99]; bias, 0.02 [limits of agreement, −0.11 to +0.15], respectively). Conclusions Standardization of lung‐to‐head ratio measurements improves prediction of neonatal outcomes. Further studies are needed to confirm these results and to assess the utility of standardization of other prognostic parameters.