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Reliability of two-dimensional echocardiography in the assessment of clinically significant abnormal hemidiaphragm motion in pediatric cardiothoracic patients: Comparison with fluoroscopy.

Publication ,  Journal Article
Miller, SG; Brook, MM; Tacy, TA
Published in: Pediatr Crit Care Med
September 2006

OBJECTIVE: To assess the utility and reliability of echocardiographic assessment of hemidiaphragm motion abnormalities in pediatric cardiothoracic patients. DESIGN: Retrospective observational study, with post hoc blinded assessment of echocardiographic and fluoroscopic results. SETTING: Tertiary care center. PATIENTS: Thirty-six consecutive pediatric cardiothoracic patients with suspected hemidiaphragm paralysis were identified and included in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The results of both echocardiographic and fluoroscopic studies on all patients were included. In addition, blinded review of study results were performed. The sensitivity and specificity of fluoroscopy in identifying hemidiaphragms that needed plication were 100% and 74%, respectively. The positive predictive value was 55%; negative predictive value was 100%. Comparing reported diagnoses with blinded review of the studies showed poor agreement; reviewers agreed with 89% diagnosed as normal, 44% of paralyzed, and 76% of paradoxical hemidiaphragms. The sensitivity and specificity of echo in identifying hemidiaphragms that needed plication were 100% and 81%, respectively. The positive predictive value and negative predictive value were 66% and 100%. Comparing reported diagnoses with blinded review, reviewers agreed with 97% diagnosed as normal, 81% of paralyzed, and 100% of paradoxical hemidiaphragms. Echocardiography was less accurate in discriminating between paralyzed and paradoxical diaphragm motion. Echocardiography was specific for paradoxical motion, since both patients identified by echocardiography were confirmed by fluoroscopy, but it was not sensitive. In nine patients, echo showed paralyzed motion that was identified by fluoroscopy as paradoxical. CONCLUSIONS: This study supports the use of echocardiography in the assessment of diaphragm function. When the diaphragms are clearly visualized by echo, as they are in the majority of cases, the addition of an additional fluoroscopic study adds no clinical value. The differentiation between paralyzed and paradoxical motion is unreliable by both imaging modalities.

Duke Scholars

Published In

Pediatr Crit Care Med

DOI

ISSN

1529-7535

Publication Date

September 2006

Volume

7

Issue

5

Start / End Page

441 / 444

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Respiratory Paralysis
  • Reproducibility of Results
  • Predictive Value of Tests
  • Phrenic Nerve
  • Pediatrics
  • Male
  • Infant, Newborn
  • Infant
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Miller, S. G., Brook, M. M., & Tacy, T. A. (2006). Reliability of two-dimensional echocardiography in the assessment of clinically significant abnormal hemidiaphragm motion in pediatric cardiothoracic patients: Comparison with fluoroscopy. Pediatr Crit Care Med, 7(5), 441–444. https://doi.org/10.1097/01.PCC.0000227593.63141.36
Miller, Stephen G., Michael M. Brook, and Theresa A. Tacy. “Reliability of two-dimensional echocardiography in the assessment of clinically significant abnormal hemidiaphragm motion in pediatric cardiothoracic patients: Comparison with fluoroscopy.Pediatr Crit Care Med 7, no. 5 (September 2006): 441–44. https://doi.org/10.1097/01.PCC.0000227593.63141.36.
Miller, Stephen G., et al. “Reliability of two-dimensional echocardiography in the assessment of clinically significant abnormal hemidiaphragm motion in pediatric cardiothoracic patients: Comparison with fluoroscopy.Pediatr Crit Care Med, vol. 7, no. 5, Sept. 2006, pp. 441–44. Pubmed, doi:10.1097/01.PCC.0000227593.63141.36.

Published In

Pediatr Crit Care Med

DOI

ISSN

1529-7535

Publication Date

September 2006

Volume

7

Issue

5

Start / End Page

441 / 444

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Respiratory Paralysis
  • Reproducibility of Results
  • Predictive Value of Tests
  • Phrenic Nerve
  • Pediatrics
  • Male
  • Infant, Newborn
  • Infant
  • Humans