Elsevier

The Journal of Pediatrics

Volume 152, Issue 1, January 2008, Pages 90-95.e3
The Journal of Pediatrics

Original article
A New Scoring System for Computed Tomography of the Chest for Assessing the Clinical Status of Bronchopulmonary Dysplasia

https://doi.org/10.1016/j.jpeds.2007.05.043Get rights and content

Objective

To develop a new scoring system for computed tomography (CT) of the chest for assessing the clinical status of patients with bronchopulmonary dysplasia (BPD) in comparison with a modified Edwards roentgenographic scoring system.

Study design

Preterm infants diagnosed with BPD (n = 42) were assessed prospectively by chest CT scan at the time of discharge. Three radiologists classified the CT findings into 1 of 3 categories—hyperexpansion, emphysema, or fibrous/interstitial abnormalities—and developed a new scoring system. We assessed interobserver reproducibility and investigated whether this classification system reflected the severity of BPD in these patients.

Results

The CT scores had acceptable reproducibility (coefficient of correlation [cc] = 0.721 to 0.839). The subgroup with a more severe form of BPD had a higher CT score. The CT score correlated with the clinical score at 36 weeks of postmenstrual age (cc = 0.367) and the duration of oxygen therapy (cc = 0.537). Patients who were discharged home on oxygen had higher CT scores than patients who were not.

Conclusions

The new chest CT scoring system may have higher objectivity and accuracy in terms of predischarge assessment of clinical status as well as prediction of the prognosis of patients with BPD.

Section snippets

Patients

A total of 401 preterm infants under 37 weeks GA were hospitalized in the neonatal intensive care units of 3 hospitals (Kyushu University Hospital, National Hospital Organization Kyushu Medical Center, and Fukuoka Municipal Children’s Hospital) between July 1998 and January 2004 (Figure 1; available at www.jpeds.com); 51 of these infants (12.7%) developed BPD. After the hospitals’ Institutional Review Boards approved the study protocol, informed consent was obtained from the infants’

Interobserver Reproducibility

First, to confirm the objectivity and accuracy of the CT system, the reports from the radiologists were tested for interobserver reproducibility using Spearman’s rank-sum test and kappa statistics. The CT scores demonstrated close association among the radiologists (cc = 0.721 to 0.839; all P < .05; data not shown). Agreement between the radiologists in scoring each finding varied from κ = 0.059 to 0.444 for the mosaic pattern of lung attenuation to κ = 0.492 to 0.710 for the size of bullae and

Discussion

The CT scores significantly correlated with both the clinical scores at 36 weeks PMA and the duration of oxygen therapy. The CT scores were higher in patients who had more severe BPD, as well as in those who were discharged home on oxygen. On the other hand, the roentgenographic scores at 28 days of life, but not at 36 weeks PMA, correlated with both the clinical scores and the durations of oxygen therapy and the mechanical ventilation. Therefore, the CT scoring system may be reasonable for

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