Browsing by Subject "congenital diaphragmatic hernia"

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    Inter- and Intra-rater Reliability of A Grading System for Congenital Diaphragmatic Hernia Defect Size
    (Elsevier, 2019-01) Hunter, Chelsea E.; Saenz, Zoe M.; Nunez, Daisy; Timsina, Lava; Gray, Brian W.; Surgery, School of Medicine
    Background The Congenital Diaphragmatic Hernia Study Group (CDHSG) registry is a multi-institutional tool to track outcomes of patients with CDH. The CDHSG asks surgeons to categorize diaphragmatic defect sizes as type A-D based on published guidelines. The reported size of the defect has been correlated with patient outcomes, but the reliability of this system has never been studied. Our goal was to evaluate the inter- and intra-rater reliability of the CDHSG grading system. Materials and methods Forty-six operative notes from CDH patients that underwent surgical repair at a single institution were collected and cropped to include only the information necessary to grade the hernia defect based on the CDHSG guidelines. The defects were graded by nine pediatric surgeons on two separate occasions (18 wk apart). Inter-rater reliability was calculated using a Cohen's kappa (κ). Intra-rater reliability was calculated using an intraclass correlation coefficient. Results Inter-rater reliability was minimal to weak (κ round1 = 0.395, κ round2 = 0.424). Agreement ranged from 19.57% (κ = −0.0745) to 82.61% (κ = 0.7543). Inter-rater agreement was similar despite operative findings and outcomes: survival yes/no (κ = 0.3690, κ = 0.3518), need for ECMO yes/no (κ = 0.3323, κ = 0.3362), patch repair yes/no (κ = 0.2050, κ = 0.1916), and liver up/down (κ = 0.2941, κ = 0.4404). Intra-rater reliability was good to excellent (intraclass correlation coefficient = 0.88, 95% CI [0.83-0.92]). Agreement with oneself ranged from 71.74% to 93.48%. Conclusions The demonstrated weak inter-rater reliability of the current CDHSG grading system shows the need for improvement in how the grading system is applied by surgeons when reporting CDH defect size.
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    Prenatal Predictors of Survival in Isolated Congenital Diaphragmatic Hernia: A Systematic Review and Meta-analysis
    (Wolters Kluwer, 2024-09) Tofte, Alena; Aghajani, Faezeh; Jawwad, Mohammad; Flood, Anna; D’Antonio, Francesco; Khalil, Asma; Mustafa, Hiba; Obstetrics and Gynecology, School of Medicine
    OBJECTIVE: To evaluate prenatal fetal imaging findings associated with survival to hospital discharge, persistent pulmonary hypertension (PH), and need for extracorporeal membrane oxygenation (ECMO) in fetuses with isolated congenital diaphragmatic hernia (CDH) that are undergoing prenatal expectant management. DATA SOURCES: A systematic search was conducted in MEDLINE through PubMed, EMBASE, Web of Science, and The Cochrane Central, and ClinicalTrials.gov from 2000 up to July 2023. METHODS OF STUDY SELECTION: Studies that reported on prenatal imaging in fetuses with isolated CDH that were undergoing expectant management were included. Primary outcomes were survival to hospital discharge, persistent PH within 28 days of age, and need for ECMO. The quality of studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed when at least two studies reported on the same prenatal imaging evaluation. Subgroup analyses were performed according to the side (left or right) of CDH. TABULATION, INTEGRATION, AND RESULTS: A total of 161 full-text articles were assessed for eligibility, with 48 studies meeting the inclusion criteria: 45 (N=3,977) assessed survival, eight (N=994) assessed persistent PH, and 12 (N=2,085) assessed need for ECMO. The pooled proportion was 2,833 of 3,977 (71.2%, 95% CI, 69.8–72.6%) for survival, 565 of 2,085 (27.1%, 95% CI, 25.2–29.1%) for need for ECMO, and 531 of 994 (53.4%, 95% CI, 50.3–56.6%) for need for persistent PH. Prenatal imaging findings that were significantly associated with survival included: total fetal lung volume (mean difference [MD] 13.42, 95% CI, 11.22–15.62), observed-to-expected (O-E) total fetal lung volume less than 30% (odds ratio [OR] 0.09, 95% CI, 0.05–0.17), O-E total fetal lung volume (MD 14.73, 95% CI, 11.62–17.84, I2 46%), liver/intrathoracic ratio (MD −9.59, 95% CI, −15.73 to −3.46), O-E lung/head ratio (MD 14.03, 95% CI, 12.69–15.36), O-E lung/head ratio less than 25% (OR 0.07, 95% CI, 0.04–0.13), mediastinal shift angle (MD −6.17, 95% CI, −7.70 to −4.64), stomach position in mid-chest (OR 0.14, 95% CI, 0.06–0.36), and intrathoracic liver (OR 0.23, 95% CI, 0.15–0.35). In subgroup analyses, findings for left-sided CDH remained significant in all the aforementioned findings. The only prenatal imaging finding that was significantly associated with persistent PH was intrathoracic liver (OR 1.96, 95% CI, 1.14–3.37), but this association was no longer significant in subgroup analyses. Prenatal imaging findings that were significantly associated with need for ECMO included: O-E total fetal lung volume (MD −10.08, 95% CI, −13.54 to −6.62), O-E lung/head ratio (MD −9.88, 95% CI, 14.44 to −5.33, I2 30%), subgroup analysis to the left-sided CDH remained significant, percentage of predicted lung volume (MD −9.81, 95% CI, −13.56 to −6.06, I2 34%), and intrathoracic liver (OR 2.70, 95% CI, 1.60–4.57, I2 0%), but this association was no longer significant in left-sided CDH subgroup analysis. CONCLUSION: Several prenatal imaging findings, including lung measurements, intrathoracic liver, and stomach position, were predictive of neonatal survival. Lung measurement was predictive of need for ECMO, and intrathoracic liver was significantly associated with persistent PH and need for ECMO.