Interrater Reliability in Interpretation of Neuropathic Pediatric Urodynamic Tracings: An Expanded Multicenter Study
Interrater Reliability in Interpretation of Neuropathic Pediatric Urodynamic Tracings: An Expanded Multicenter Study
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DOI：
10.1016/j.juro.2017.12.051
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发表时间：
2018-05-01
影响因子：
6.6
通讯作者：
Tanaka, Stacy T.
中科院分区：
文献类型：
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作者：
Dudley, Anne G.;Adams, Mark C.;Tanaka, Stacy T.
目的：尿动力学结果经常指导神经性膀胱的治疗，在多机构试验中被报道为客观数据点。然而，尿动力学解释可以是可变的。在一项初步研究中，儿科泌尿科医生对视频尿流动力学的解释只表现出适度的一致性，尽管培训和实践模式相似。材料和方法：我们开发了一项匿名的电子调查，其中包含20个场景，每个场景都有简短的患者病史、1个尿流动力学示踪和透视图像。所有视频尿流动力学均在同一机构神经性膀胱患者的常规护理过程中完成。来自疾病控制和预防中心泌尿外科网站的儿科泌尿科医生被邀请为每种情况完成一份解释仪器。报告了Fleiss kappa和95%的可信区间，Fleiss kappa为1.00，符合完全一致。结果：调查由7个机构的14名儿科泌尿外科医生完成。在评估透视下的膀胱形状(Fleiss kappa 0.73)方面有很大的一致性，而在评估膀胱安全性、末端充盈逼尿肌压力和膀胱容量方面有一定的一致性(Fleiss kappa分别为0.50、0.56和0.54)。肌电的协同作用和逼尿肌过度活动的存在被认为是相当一致的(Fleiss kappa分别为0.21和0.35)。结论：有经验的儿科泌尿科医生在解释视频动力学轨迹时表现出变异性。在这项扩大的研究中，肌电活动和逼尿肌过度活动评估的主观性得到了证实。未来提高视频尿流动力学解释可靠性的工作将改善临床护理的质量和使用尿流动力学数据点作为结果的多机构研究的质量。
Purpose: Urodynamic findings often guide treatment for neuropathic bladder and are reported as objective data points in multi-institutional trials. However, urodynamic interpretation can be variable. In a pilot study pediatric urologists interpreting videourodynamics exhibited only moderate agreement despite similar training and practice patterns. We hypothesized the pilot study variability would be replicated in a multi-institutional study.Materials and Methods: We developed an anonymous electronic survey that contained 20 scenarios, each with a brief patient history, 1 urodynamic tracing and fluoroscopic imagery. All videourodynamics were completed during routine care of patients with neuropathic bladder at a single institution. Pediatric urologists from Centers for Disease Control and Prevention Urologic Protocol sites were invited to complete an interpretation instrument for each scenario. Fleiss kappa and 95% confidence limits were reported, with Fleiss kappa 1.00 corresponding to perfect agreement.Results: The survey was completed by 14 pediatric urologists at 7 institutions. Substantial agreement was seen for assessment of fluoroscopic bladder shape (Fleiss kappa 0.73), while moderate agreement was observed for assessment of bladder safety, end filling detrusor pressure and bladder capacity (Fleiss kappa 0.50, 0.56 and 0.54, respectively). Fair agreement was seen for electromyographic synergy and presence of detrusor overactivity (Fleiss kappa 0.21 and 0.35, respectively).Conclusions: Experienced pediatric urologists demonstrate variability during interpretation of videourodynamic tracings. Subjectivity of assessment of electromyographic activity and detrusor overactivity was confirmed in this expanded study. Future work to improve the reliability of videourodynamic interpretation would improve the quality of clinical care and the quality of multi-institutional studies that use urodynamic data points as outcomes.