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CC BY 4.0 · Eur J Pediatr Surg 2025; 35(03): 232-239
DOI: 10.1055/a-2466-6407
Original Article

Evaluating Inter- and Intraobserver Agreement on Pectus Carinatum Severity and Treatment Outcomes: A Comparison of Subjective and Objective Assessment Methods

Hendrik van Braak 
1   Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
2   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
,
Sjoerd A. de Beer
1   Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
,
Sander Zwaveling
1   Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
,
Matthijs W. N. Oomen
1   Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
,
L W. Ernest van Heurn
1   Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
2   Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
,
Justin R. de Jong
1   Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
› Author Affiliations Funding No funds, grants, or other support were received during the preparation of this manuscript.
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Abstract

Background Visual examination is crucial for assessing pectus carinatum (PC) severity and treatment results. This cross-sectional study evaluates the inter- and intraobserver agreement of PC deformities before and after treatment.

Methods Observers examined medical photographs of patients before and after treatment. Primary outcome was inter- and intraobserver agreement on esthetic results after treatment. Secondary outcomes included inter- and intraobserver agreement on severity and symmetry before treatment, differences in esthetic results after Ravitch surgery and dynamic compression bracing (DCS bracing), and the impact of scars, age, and treatment duration on esthetic results.

Results Medical photographs of 201 patients (aged 4–18) were evaluated by five surgeons and five peers. Surgeons and peers demonstrated inadequate (κ < 0.61) interobserver agreement on esthetic results (κ = 0.26, κ = 0.22), severity of PC (κ = 0.43, κ = 0.38), and symmetry (κ = 0.37, surgeons only). Agreement between surgeons and peers on esthetic results (κ = 0.37) and severity before treatment (κ = 0.54) was similarly inadequate. Surgeons and peers demonstrated inadequate intraobserver agreement on esthetic results (κ = 0.49, κ = 0.34), severity of PC (κ = 0.54, κ = 0.48), and symmetry (κ = 0.60, surgeons only). Deformities treated with Ravitch surgery were perceived as more severe but yielded better results. Peers, unlike surgeons, viewed scars as negatively impacting results. No relationship was found between results after treatment and treatment duration (p = 0.682, p = .062) or age (p = 0.205, p = .527).

Conclusions Subjective assessment of PC severity and esthetic results is inconsistent. Three-dimensional scanning could help standardize treatment completion and aid patients and surgeons in determining treatment completion. The psychosocial effects of scars should be addressed when discussing treatment options.

Keywords

pectus carinatum - intraobserver agreement - interobserver agreement - DCS bracing - Ravitch surgery


Publication History

Received: 11 April 2024

Accepted: 10 November 2024

Accepted Manuscript online:
13 November 2024

Article published online:
02 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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