PRECISION AND ACCURACY OF CLINICAL SIGNS IN INFANTS AT RISK OF PATENT DUCTUS ARTERIOSUS (PDA)

Abstract

Although screening of premature infants for PDA with L→R shunt is a dally nursery routine, little is known about the precision (observer agreement) and accuracy (agreement with gold standard) of the clinical exam. Both were studied prospectively on days 3-7 in 100 infants With BW 60% and ↑ pulmonary vascular markings (PVM) on concurrent CXR. Colour flow doppler echocardiography was performed within 4 hours. All 100 tapes were reviewed by a 2nd cardiologist who was masked to the clinical signs. Twenty-four infants had a PDA on this gold standard test. A third of the entire cohort was intubated at the time of study. Precision of clinical signs was modest, with average kappas of 0.15 (or pulse ..