337 - Effectiveness of the Canadian Consensus Approach for Diagnosis and Grading of Preterm Brain Injury from Cranial Ultrasound

Poster Number: 337

Lara M. Leijser, University of Calgary, Calgary, AB, Canada; James Scott, University of Calgary, Calgary, AB, Canada; Hussein Zein, University of Calgary, Calgary, AB, Canada; Khorshid mohammad, Alberta Health Services, Calgary, AB, Canada

Background: Cranial ultrasound (cUS) is the first-line tool to screen the preterm infant’s brain for injury. Concerns, however, remain regarding the variability in diagnosis and grading of common preterm brain injury types from cUS between clinicians.

Objective: We explored the effectiveness of our recently developed Canadian consensus approach in decreasing this variability by assessing the interobserver agreement in diagnosis and grading of preterm brain injury from cUS between clinicians in Neonatology and Radiology pre- and post-implementation.

Design/Methods: Retrospective study in extremely preterm infants ( < 29 weeks) with ≥3 cUS throughout the neonatal period and admitted to Calgary neonatal units between 2010-2019 (pre-) and in 2021 (post-implementation). All available cUS were assessed twice by an experienced Neonatologist and Radiologist for: Presence and grade of germinal matrix-intraventricular hemorrhage (GMH-IVH; with grade 3 defined as IVH with anterior horn width of ipsilateral lateral ventricle >6mm), and associated periventricular hemorrhagic infarction (PVHI), post-hemorrhagic ventricular dilatation (PHVD; enlarged ventricular measurements on repeated cUS), cystic white matter injury (cWMI) and cerebellar hemorrhage (CBH). Interobserver agreement (intra-class correlation coefficient [ICC]) in diagnosis and grading pre- and post-consensus approach implementation was tested for all injury types. In case of inconsistency, a consensus scoring was reached through case discussion. Subsequently, ICCs were tested between the consensus scoring and Radiology reports pre- (2010-2019) and post-implementation (2021).

Results: Per consensus scoring, 331/1576 (21%) eligible infants had uni/bilateral GMH-IVH, of whom 292/1459 pre- and 39/117 post-implementation. Of the 331 infants with GMH-IVH, 96, 75, 8 and 9 infants also had PVHI, PHVD, cWMI and CBH, respectively. ICC for the Neonatologist and Radiologist was good-excellent for most injury types pre-, while excellent for all injury types post-approach implementation (table 1). More important, ICC for the consensus scoring and Radiology reports was poor-moderate for all injury types pre-, while good for most injury types post-implementation (table 1).Conclusion(s): Our consensus approach contributes to high consistency in diagnosis and grading of common and clinically significant brain injury types from cUS in extremely preterm infants. It may facilitate better identification of risk factors for preterm brain injury, and therewith improved clinical care and prediction of long-term neurodevelopmental outcomes for preterm infants based on serial cUS.

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