Accuracy and inter-rater agreement among practitioners using quick thoracic ultrasonography to diagnose calf pneumonia.

Background: Thoracic ultrasonography (TUS) is a commonly used tool for on-farm detection of pneumonia in calves. Different scanning methods have been described, but the performance of novice practitioners after training has not been documented.

Methods: In this study, 38 practitioners performed quick TUS (qTUS) on 18-23 calves each. Pneumonia was defined as lung consolidation 1 cm or more in depth. Diagnostic parameters (accuracy [Acc], sensitivity [Se] and specificity [Sp]) were compared to those of an experienced operator. Cohen's kappa and Krippendorff's alpha (Kalpha) were determined. The potential effects of training and exam sessions on performance were evaluated.

Results: The average relative Se and Sp were 0.66 (standard deviation [SD] = 0.26; minimum [Min.]-Maximum [Max.] = 0-1) and 0.71 (SD = 0.19; Min.-Max. = 0.25-1), respectively. The average relative Acc was 0.73 (SD = 0.11; Min.-Max. = 0.52-0.96). Over all sessions, Cohen's kappa averaged 0.40 (SD = 0.24; Min.-Max. = 0.014-0.90) and Kalpha was 0.24 (95% confidence interval [CI]: 0.20-0.27), indicating 'fair' agreement. Calf age and housing influenced Se and Sp. Supervised practical training improved Se by 17.5% (95% CI: 0.01-0.34).

Limitations: The separate effects of calf age and housing could not be determined.

Conclusion: This study showed that qTUS, like any other clinical skill, has a learning curve, and variability in performance can be substantial. Adequate training and certification of one's skill are recommended to assure good diagnostic accuracy.