BACKGROUND The effect of different probes and operators' experience on reliability of lung ultrasound (LU) interpretation has not been investigated.We aim to study the effect of probes and operators' experience on the interpretation reliability of LU in critically ill neonates METHODS: Prospective, blind, cohort study enrolling patients with basic patterns ("B";"severe B";consolidation).Patients were scanned with micro-linear (15 MHz;L15), phased-array sectorial (6-12 MHz;S7) and micro-convex (8 MHz;C8) probes, in random order.Static images were acquired in high resolution, anonymized and included in a pictorial database in random sequences.Seventeen clinicians with different LU experience were asked to blindly assess the pictorial database. Inter-rater agreement and interpretation reliability were analyzed.Sub-analyses according to expertise and probe, and multivariate linear regression (including an "expertise*probe" interaction factor) were also performed RESULTS: The agreement tends to be lower and more heterogeneous for residents (ICC:0.82 (95%CI:0.74-0.9),p<0.001; I2:67%,p=0.04),and for fellows (ICC:0.93 (95%CI:0.9-0.97),p<0.001; I2:69%,p=0.04),especially when using non-linear probes,compared to senior physicians (ICC:0.95 (95%CI:0.93-0.96),p<0.001; I2:0%,p=0.433).AUC values were high for all probes (L15:0.96 (95%CI:0.93-0.99); C8:0.91 (95%CI:0.85-0.98); S7:0.86 (95%CI:0.82-0.91)) and physicians (senior:0.95 (95%CI:0.83-0.99);fellows:0.95 (95%CI:0.75-0.99);residents:0.86 (95%CI:0.5-0.99)).Worse reliability and a higher heterogeneity were found when the evaluation was performed by residents (AUC:0.9 (95%CI:0.85-0.94),p<0.01; I2:93.6%,p<0.001), than by fellows (AUC:0.99 (95%CI:0.9-0.999),p<0.001; I2:34.3%,p=0.09) and/or by senior physicians (AUC:0.99 (95%CI:0.9-0.999),p<0.001; I2:18%,p=0.236).The "expertise*probe" interaction factor was associated with lower ICC (St.β:-0.69;p<0.0001;adjusted R2:0.99) and AUC (St.β:-0.76;p<0.0001;adjusted R2:0.98) CONCLUSIONS: LU interpretation in neonates shows good inter-rater agreement and reliability,irrespective of the probe and raters' expertise.The use of non-linear probes by novice operators is associated with lowest agreement and reliability.

中文翻译：

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不同探头和专业知识对床旁肺部超声解释可靠性的影响

背景 尚未研究不同探头和操作者经验对肺超声（LU）解释可靠性的影响。我们旨在研究探头和操作者经验对危重新生儿 LU 解释可靠性的影响。盲法、队列研究招募具有基本模式（“B”；“严重 B”；巩固）的患者。使用微线性（15 MHz；L15）、相控阵扇形（6-12 MHz；S7）和微-凸（8 MHz；C8）探针，随机顺序。静态图像以高分辨率获取，匿名并以随机序列包含在图片数据库中。要求具有不同 LU 经验的 17 名临床医生盲目评估图片数据库。分析了评估者间的一致性和解释的可靠性。