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. 2018 Mar;21(1):35-40.
doi: 10.1007/s40477-017-0276-z. Epub 2018 Jan 6.

Inter-rater and intra-rater reliability of the airway diameter measured by sonography

Julio César Gómez-Tamayo  1 , Jorge Iván Puerta-Guarín  2 , Claudia Marcela Rojas-Camejo  2 , Juan Pablo Caicedo  2 , José Andrés Calvache  2   3
Affiliations

Inter-rater and intra-rater reliability of the airway diameter measured by sonography

Julio César Gómez-Tamayo et al. J Ultrasound. 2018 Mar.

Abstract
in English, Italian

Introduction: Sonography has gained a broad field of applications in current anesthetic practice. During airway management, it could have an important role, because it allows real-time measurement of anatomical aspects and a functional evaluation with high safety profile. However, assessment of the reliability and precision of these measurements is critical if sonography is used as a clinical diagnostic tool. The aim of the study was to estimate inter-rater and intra-rater reliability of the airway diameter measured by sonography in heathy volunteers.

Methods: We conducted a cross-sectional study during 2015 on healthy adult volunteers. Using sonography, transverse internal diameter of subglottic space was measured twice by two blinded sonographers.

Results: Agreement was classified as very good for intra-rater measurements (ICC = 0.84) and good for the inter-rater measurements (ICC = 0.71). The 95% CI of agreement limits for the intra-rater measurements were inferior to those for the inter-rater measurements.

Conclusions: Ultrasound measurement is a reliable and precise method to measure the internal subglottic diameter of the airway. Ultimately, this method may provide clinicians valuable information regarding airway diameter in adults and may help to guide treatment options.

Scopo: L’ecografia ha acquisito nel tempo un ruolo importante in diverse applicazioni nella pratica anestesiologica corrente. Durante la gestione delle vie aeree, potrebbe avere un ruolo importante in quanto consente di misurare in tempo reale gli aspetti anatomici e una valutazione funzionale con un elevato profilo di sicurezza. Tuttavia, la valutazione dell’affidabilità e della precisione di queste misurazioni è fondamentale se l’ecografia viene utilizzata come strumento diagnostico clinico. Lo scopo di questo studio è di stimare l’affidabilità inter e intra-osservatore del diametro delle vie aeree misurate ecograficamente su volontari sani.

Metodi: Nel corso del 2015 abbiamo condotto uno studio trasversale su volontari adulti sani. Utilizzando l’ecografia, il diametro interno trasversale dello spazio subglottico è stato misurato due volte da due ecografisti in doppio cieco.

Risultati: L’accordo inter e intra-osservatore è stato classificato rispettivamente come buono (CCI = 0.71) e molto buono (CCI = 0.84). I limiti della misura di concordanza intra-osservatore con IC del 95% erano inferiori rispetto a quelli inter-osservatore.

Conclusioni: La misura dello spazio subglottico con l’ecografia è un metodo affidabile e preciso per misurare il diametro subglottico interno della via aerea. In definitiva, questo metodo può fornire ai medici informazioni preziose riguardo il diametro delle vie aeree negli adulti e può aiutare a guidare le opzioni di trattamento.

Keywords: Airway; Airway ultrasound; Precision; Reliability; Sonography; Subglottic space.

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Conflict of interest statement

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of The Institutional Research Committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

All volunteers agreed to participate and signed a written informed consent form prior to data collection.

Sources funding

None.

Figures

Fig. 1
Fig. 1
a Long axis of the trachea showing thyroid cartilage, cricoid cartilage (yellow arrows), and tracheal rings (red arrows). b Short-axis sonogram of the anatomical site corresponding to the subglottic space
Fig. 2
Fig. 2
Assessment and measurement of the transverse internal diameter (dashed line)
Fig. 3
Fig. 3
Bland–Altman plots for intra-rater agreement and inter-rater agreement (n = 100)
See this image and copyright information in PMC

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