Reliability of CXR for the diagnosis of bronchopulmonary dysplasia.

BACKGROUND: Bronchopulmonary dysplasia (BPD) continues to be prevalent, despite new treatment, in part because of increased survival in less mature infants. Investigations of new treatments have been hampered by a lack of universally accepted diagnostic criteria. Radiographic scoring systems have been developed to provide objective assessment of lung injury and risk for chronic lung disease.

OBJECTIVE: We sought to test the reliability of a recently reported system using chest radiography as the main tool for diagnosis of BPD.

MATERIALS AND METHODS: One hundred chest radiographs, half demonstrating BPD and the other half without BPD, were analyzed by pediatric radiologists and by a neonatologist, using the Weinstein score (1-6, depending on increasing radiographic severity). The reliability of this scoring system was tested by kappa (k) statistics.

RESULTS: Reliability at the lowest threshold (dividing score 1 from score > or = 2) was unacceptably low in this population. Reliability increased with inclusion of higher BPD scores in the comparison groups: 1-3 versus 4-6.

CONCLUSION: Using the chest radiograph for the prediction of BPD is not reliable between different observers except at the two extremes of the disease.