Department of Urology, Western Health, Victoria, Australia.
J Urol. 2010 Jul;184(1):231-6. doi: 10.1016/j.juro.2010.03.018. Epub 2010 May 15.
Macroscopic hematuria is a common symptom and sign that is challenging to quantify and describe. The degree of hematuria communicated is variable due to health worker experience combined with lack of a reliable grading tool. We produced a reliable, standardized visual scale to describe hematuria severity. Our secondary aim was to validate a new laboratory test to quantify hemoglobin in hematuria specimens.
Nurses were surveyed to ascertain current hematuria descriptions. Blood and urine were titrated at varying concentrations and digitally photographed in catheter bag tubing. Photos were processed and printed on transparency paper to create a prototype swatch or card showing light, medium, heavy and old hematuria. Using the swatch 60 samples were rated by nurses and laymen. Interobserver variability was reported using the generalized kappa coefficient of agreement. Specimens were analyzed for hemolysis by measuring optical density at oxyhemoglobin absorption peaks.
Interobserver agreement between nurses and laymen was good (kappa = 0.51, p <0.001). Subgroup analysis showed substantial agreement for light hematuria (kappa = 0.71). Overall agreement improved when the moderate (kappa = 0.28) and heavy (kappa = 0.53) hematuria categories were combined (kappa = 0.70). Compared to known blood concentrations the assay of optical density at oxyhemoglobin absorption peaks showed a linear trend.
A simple visual scale to grade and communicate hematuria with adequate interobserver agreement is feasible. The test for optical density at oxyhemoglobin absorption peaks is a new method, validated in our study, to quantify hemoglobin in a hematuria specimen.
肉眼血尿是一种常见的症状和体征，难以定量和描述。由于医护人员的经验以及缺乏可靠的分级工具，所传达的血尿程度存在差异。我们制作了一种可靠的、标准化的视觉量表来描述血尿的严重程度。我们的次要目标是验证一种新的实验室测试方法，以定量血尿标本中的血红蛋白。
对护士进行调查以确定当前的血尿描述。将血液和尿液在不同浓度下进行滴定，并在导尿管管中进行数字化拍摄。对照片进行处理并打印在透明纸上，以创建显示轻度、中度、重度和陈旧性血尿的原型样本或卡片。使用样本，由护士和非专业人员对 60 个样本进行评分。使用广义kappa 系数来报告观察者间的变异性。通过测量氧合血红蛋白吸收峰处的光密度来分析标本的溶血情况。
护士和非专业人员之间的观察者间一致性良好（kappa = 0.51，p <0.001）。亚组分析显示，轻度血尿的一致性较高（kappa = 0.71）。当将中度（kappa = 0.28）和重度（kappa = 0.53）血尿类别合并时，总体一致性得到改善（kappa = 0.70）。与已知的血液浓度相比，氧合血红蛋白吸收峰处的光密度测定显示出线性趋势。
一种简单的视觉量表，可以对血尿进行分级和交流，并且观察者间具有足够的一致性，这是可行的。氧合血红蛋白吸收峰处的光密度测试是一种新的方法，在本研究中得到了验证，可以定量血尿标本中的血红蛋白。
