Inter- and Intraobserver Agreement for Gastroesophageal Reflux Detection in Infants Using Multiple Intraluminal Impedance

Abstract

The multiple intraluminal impedance (MII) technique is a new method that allows pH-independent gastroesophageal reflux detection via changes in impedance caused by a liquid bolus inside the esophagus. We wanted to know whether this technique yields objective and reproducible results. Twenty 3- to 6-hour recordings of MII from 19 preterm infants (median gestational age at birth 30 weeks, range 24–34 weeks; age at study 26 days, range 13–93 days) were divided into 23-second segments and analyzed for reflux episodes by three investigators; one investigator analyzed the data set twice. Observer agreement was assessed using kappa statistics. Each investigator analyzed 16,627 23-second segments, with a median of 854 (range 486–979) segments per recording. Median kappa values for the 20 recordings were 0.79, 0.83, and 0.83 for the three pairs of investigators and 0.84 for the repeated scoring procedure. MII recordings could be analyzed with a high level of inter- and intraobserver agreement.