Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approachReport as inadecuate

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BMC Anesthesiology

, 14:94

Critical care


BackgroundTo assess the value of a score-based system which allows standardized evaluation of pulmonary edema on bedside chest radiographs CXRs under routine clinical conditions.

MethodsSeven experienced readers assessed bedside CXRs of ten patients with an extravascular lung water EVLW-value of ≤ 8 mL-kg range: 4–8 mL-kg; indicates no pulmonary edema and a series of ten patients with an EVLW-value of ≥ 15 mL-kg range: 15–21 mL-kg; = indicates a pulmonary edema with and without customized software which would permit a standardized assessment of the various indications of pulmonary edema. The software provides a score that identifies patients with and without pulmonary edema. EVLW-values were measured instantly after bedside CXR imaging using a pulse contour cardiac output PiCCO system and served as a reference standard. The patients were non-traumatic and not treated with diuretics or dobutamine during bedside CXR imaging and the PiCCO measurements. Mean sensitivity, specificity, positive and negative predictive value, the percentage of overall agreement and the free-marginal multirater kappa value was calculated for both the standard and the standardized score-based approach. The net reclassification index was calculated for each reader as well as for all readers.

ResultsEvaluation of bedside CXRs by means of the score-based approach took longer 23 ± 12 seconds versus 7 ± 3 seconds without the use of the software but improved radiologists’ sensitivity from 57 to 77%, specificity from 90 to 100% and the free-marginal multirater kappa value from 0.34 to 0.68. The positive predictive value was raised from 85 to 100% and the negative predictive value from 68 to 81%. A net reclassification index of 0.3 all readers demonstrates an improvement in prediction performance gained by the score-based approach. The percentage of overall agreement was 67% with the standard approach and 84% with the software-based approach.

ConclusionsThe diagnostic accuracy of bedside CXRs to discriminate patients with elevated EVLW-values from those with a normal value can be improved with the use of a standardized score-based approach. The investigated system is freely available as a web-based application accessible via:

KeywordsBedside chest radiograph Pulmonary edema Scoring system Extravascular lung water EVLW Web-based application AbbreviationsPiCCOPulse contour cardiac output

EVLWExtravascular lung water

ICUIntensive care unit

CXRChest radiograph.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2253-14-94 contains supplementary material, which is available to authorized users.

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Author: Matthias Hammon - Peter Dankerl - Heinz Leonhard Voit-Höhne - Martin Sandmair - Ferdinand Josef Kammerer - Michael Uder -


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