Intra- and interrater reliability of quantitative ultrasound assessment of gastric content in patients with term pregnancy prior to elective Cesarean delivery
Authors' conclusion
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.
Study context
- Population
- Term pregnancy (≥ 37 weeks) scheduled for elective Cesarean delivery under neuraxial anesthesia, following institutional fasting guidelines28 analysed
- Participants
- 30 participants
- Exposure
- Experienced vs novice anesthesiologists
- Outcome
- Antral CSA, used to calculate intra- and interrater reliability between the two levels of expertise
Methodological detailsraters blinded to each other's assessments, random order of raters
- Raters blinded to each other's assessments
- Random order of raters
Main finding
As reported in the abstract
Antral CSA reliability (ICC)
- Median antral cross-sectional area (CSA), supine
- 4.7 cm²
- Median antral CSA, right lateral decubitus (RLD)
- 8.4 cm²
- Intrarater reliability "good" to "excellent", irrespective of expertise and position
- 0.88 (intraclass correlation coefficient (ICC); 95% CI LL 0.80)
- Interrater reliability between expertise levels "moderate", supine
- 0.52 (ICC; 95% CI LL 0.2)
- Interrater reliability between expertise levels "poor", RLD
- 0.47 (ICC; 95% CI LL 0.14)
Observational data: associations, not effects.
Secondary outcomes
Antral grade (0-2), interrater reliability novice vs experienced
- Moderate (kappa)
- 0.50
Gastric volume estimation
- Similar in both levels of expertise
Agreement among raters at determining CSA ≤ 10 cm², RLD
- Agreement (95% CI LL 51); overall underestimation in novice raters
- 71%
Original publication
Intra- and interrater reliability of quantitative ultrasound assessment of gastric content in patients with term pregnancy prior to elective Cesarean delivery. Can J Anaesth. Published 4 June 2026. doi:10.
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