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Radiologists' Agreement When Using a 10-Point Scale to Report Abdominal Radiographic Findings of Necrotizing Enterocolitis in Neonates and Infants

¹ Department of Radiology, Duke University Medical Center, Erwin Rd., Box 3808, Durham, NC 27710.
² Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.

OBJECTIVE. The purpose of this study was to evaluate radiologists' agreement when using a 10-point scale of abnormal findings designed to standardize reporting of abdominal radiographs in neonates or infants with suspected necrotizing enterocolitis.

MATERIALS AND METHODS. A 10-point scale of radiographic findings was devised at our institution and was in use for approximately 18 months before the initiation of this study. After institutional review board approval, 88 abdominal radiographs (anteroposterior and cross-table lateral) were randomly selected for review, allowing for an equal distribution of examinations throughout the scale according to the original examination report. The mean age of the patients in the total study population was 24.9 days (range, 0–56 days); 61 patients (47.3%) were girls and 68 (52.7%) were boys. Four pediatric radiologists having 20, 13, 7, and 5 years of experience scored images twice at least 4 weeks apart according to the scale, which was designed to characterize certainty and severity of disease in neonates and infants with possible necrotizing enterocolitis. Interobserver and intraobserver agreement was assessed by applying weighted kappa statistics. Operative and pathology reports were reviewed.

RESULTS. The average intraobserver weighted kappa value was 0.792 (SD, 0.025; range, 0.635–0.946). The average interobserver weighted kappa value was 0.665 (SD, 0.035, range, 0.574–0.898).

CONCLUSION. Substantial intraobserver and interobserver agreement was found when radiologists used a 10-point scale to report abnormal findings on abdominal radiographs in neonates or infants with suspected necrotizing enterocolitis. This scale warrants further evaluation as a potentially useful clinical tool.

Keywords: enterocolitis • necrotizing enterocolitis • observer agreement • pediatric imaging • radiography • radiologists • radiology reporting systems • scale of abnormal radiographic findings of necrotizing enterocolitis

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