Reliability of CXR for the diagnosis of bronchopulmonary dysplasia

Background. Bronchopulmonary dysplasia (BPD) continues to be prevalent, des pite new treatment, in part because of increased survival in less mature in fants. Investigations of new treatments have been hampered by a lack of uni versally accepted diagnostic criteria. Radiographic scoring systems have be en developed to provide objective assessment of lung injury and risk for ch ronic 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 BP D and the other half without BPD, were analyzed by pediatric radiologists a nd by a neonatologist, using the Weinstein score (1-6, depending on increas ing radiographic severity). The reliability of this scoring system was test ed by kappa (k) statistics. Results. Reliability at the lowest threshold (dividing score 1 from score g reater than or equal to 2) was unacceptably low in this population. Reliabi lity 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 rel iable between different observers except at the two extremes of the disease .