Abstract
Background/purpose: Among patients suspected of pectus excavatum, visual examination is a key aspect of diagnosis and, moreover, guides work-up and treatment strategy. This study evaluated the inter observer and intra-observer agreement of visual examination and diagnosis of pectus excavatum among experts. Methods: Three-dimensional surface images of consecutive patients suspected of pectus excavatum were reviewed in a multi-center setting. Interactive three-dimensional images were evaluated for the presence of pectus excavatum, asymmetry, flaring, depth of deformity, cranial onset, overall severity and morphological subtype through a questionnaire. Observers were blinded to all clinical patient information, completing the questionnaire twice per subject. Agreement was analyzed by kappa statistics. Results: Fifty-eight subjects with a median age of 15.5 years (interquartile range: 14.1-18.2) were evaluated by 5 (cardio)thoracic surgeons. Pectus excavatum was visually diagnosed in 55% to 95% of cases by different surgeons, revealing considerable inter-observer differences (kappa: 0.50; 95%-confidence interval [CI]: 0.41-0.58). All other items demonstrated inter-observer kappa's of 0.25-0.37. Intra-observer analyses evaluating the presence of pectus excavatum demonstrated a kappa of 0.81 (95%-CI: 0.72-0.91), while all other items showed intra-observer kappa's of 0.36-0.68. Conclusions: Visual examination and diagnosis of pectus excavatum yields considerable inter-observer and intra-observer disagreements. As this variation in judgement could impact work-up and treatment strategy, objective standardization is urged. Levels of evidence: III. (c) 2021 Elsevier Inc. All rights reserved.
Original language | English |
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Pages (from-to) | 526-531 |
Number of pages | 6 |
Journal | Journal of Pediatric Surgery |
Volume | 57 |
Issue number | 3 |
DOIs | |
Publication status | Published - 1 Mar 2022 |
Keywords
- Pectus excavatum
- Visual assessment
- Diagnosis
- Inter-observer agreement
- Intra-observer agreement
- NUSS PROCEDURE
- REPAIR
- CT