Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026
Intra- and interrater reliability of quantitative ultrasound assessment of gastric content in patients with term pregnancy prior to elective Cesarean delivery.
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Ghiringhelli Juan P, Siddiqui Naveed, Kordich Lada, Carvalho Jose C A, George Ronald B, Downey Kristi, Wang Stella, Huszti Ella, Arzola Cristian
Аннотация
PURPOSE: Bedside gastric ultrasound provides information about the content and volume of the stomach, helping stratify the perioperative aspiration risk. We aimed to assess the intra- and interrater reliability of antral cross-sectional area (CSA) measurements, performed by anesthesiologists with different expertise levels, in patients with term pregnancy before elective Cesarean delivery.
METHODS: We conducted a prospective study on patients with term pregnancy at ≥ 37 weeks gestational age who were scheduled for elective Cesarean delivery under neuraxial anesthesia and who had been following institutional fasting guidelines. The raters were four anesthesiologists with two levels of expertise (two experienced and two novice). Each participant was assessed by two raters, one of each level of expertise, in a random order with both raters blinded to each other's assessments. A standardized technique was employed using a portable ultrasound system with patients in the supine position and then in the right lateral decubitus (RLD) position. Three measurements were taken in each position by each rater. The primary outcome was the antral CSA, used to calculate the intra- and interrater reliability between the two levels of expertise. Secondary outcomes included the qualitative assessment of the antrum and volume estimation of the stomach (mL, mL·kg-1).
RESULTS: Of 30 enrolled participants, two were excluded, leaving 28 for analysis. The median antral CSA was 4.7 cm2 and 8.4 cm2 in the supine and RLD positions, respectively. The intraclass correlation coefficient (ICC) for the intrarater reliability was "good" to "excellent" (ICC, 0.88; 95% confidence interval lower limit [CI LL], 0.80), irrespective of the level of expertise and examination position. Between the two levels of expertise, the interrater reliability was "moderate" in the supine position (ICC, 0.52; 95% CI LL, 0.2) and "poor" in the RLD position (ICC, 0.47; 95% CI LL, 0.14). The interrater reliability between the novice and experienced raters for the antral grade (0-2) was moderate (kappa = 0.50). The volume estimation was similar in both levels of expertise. There was 71% (95% CI LL, 51) agreement among raters at determining a CSA ≤ 10 cm2 in the RLD position, with an overall underestimation of the measurements in novice raters.
CONCLUSIONS: Experienced and novice anesthesiologists performing bedside gastric ultrasound showed "good" to "excellent" intrarater reliability. Nevertheless, interrater reliability was "poor" to "moderate". Clinically, the volume estimation of the stomach yielded similar results among raters. This study highlights the challenge of transferring gastric ultrasound skills to novice operators while also underscoring the importance of continued practice among experienced ones.
METHODS: We conducted a prospective study on patients with term pregnancy at ≥ 37 weeks gestational age who were scheduled for elective Cesarean delivery under neuraxial anesthesia and who had been following institutional fasting guidelines. The raters were four anesthesiologists with two levels of expertise (two experienced and two novice). Each participant was assessed by two raters, one of each level of expertise, in a random order with both raters blinded to each other's assessments. A standardized technique was employed using a portable ultrasound system with patients in the supine position and then in the right lateral decubitus (RLD) position. Three measurements were taken in each position by each rater. The primary outcome was the antral CSA, used to calculate the intra- and interrater reliability between the two levels of expertise. Secondary outcomes included the qualitative assessment of the antrum and volume estimation of the stomach (mL, mL·kg-1).
RESULTS: Of 30 enrolled participants, two were excluded, leaving 28 for analysis. The median antral CSA was 4.7 cm2 and 8.4 cm2 in the supine and RLD positions, respectively. The intraclass correlation coefficient (ICC) for the intrarater reliability was "good" to "excellent" (ICC, 0.88; 95% confidence interval lower limit [CI LL], 0.80), irrespective of the level of expertise and examination position. Between the two levels of expertise, the interrater reliability was "moderate" in the supine position (ICC, 0.52; 95% CI LL, 0.2) and "poor" in the RLD position (ICC, 0.47; 95% CI LL, 0.14). The interrater reliability between the novice and experienced raters for the antral grade (0-2) was moderate (kappa = 0.50). The volume estimation was similar in both levels of expertise. There was 71% (95% CI LL, 51) agreement among raters at determining a CSA ≤ 10 cm2 in the RLD position, with an overall underestimation of the measurements in novice raters.
CONCLUSIONS: Experienced and novice anesthesiologists performing bedside gastric ultrasound showed "good" to "excellent" intrarater reliability. Nevertheless, interrater reliability was "poor" to "moderate". Clinically, the volume estimation of the stomach yielded similar results among raters. This study highlights the challenge of transferring gastric ultrasound skills to novice operators while also underscoring the importance of continued practice among experienced ones.