O'Neil Brock B, Cartwright Patrick C, Maves Constance, Hoeg Karin, Presson Angela P, Wallis M Chad
Division of Urology, University of Utah, Primary Children's Medical Center, 30 North 1900 East, Salt Lake City, UT 84132, USA.
Division of Urology, University of Utah, Primary Children's Medical Center, 30 North 1900 East, Salt Lake City, UT 84132, USA.
J Pediatr Urol. 2014 Feb;10(1):107-11. doi: 10.1016/j.jpurol.2013.06.014. Epub 2013 Jul 25.
The voiding cystourethrogram (VCUG) is a commonly employed radiographic test used in the management of vesicoureteral reflux (VUR). Recently, the reliability of VCUG to accurately grade VUR has been questioned. The purpose of this study is to examine reliability of the VCUG for the grading of VUR in a setting mimicking daily practice in a busy pediatric hospital.
Two-hundred consecutive VCUGs were independently graded by two pediatric urologists and two pediatric radiologists according to the International Classification of Vesicoureteral Reflux. A weighted kappa coefficient was calculated to determine inter-rater agreement and a modified McNemar test was performed to assess rater bias. Further assessment for impact on clinical and research decision-making was made for disagreement between grades II and III.
Weighted kappa values reflect strong reliability of VCUG for grading VUR between and among urologists and radiologists ranging from 0.95 to 0.97. There was statistically significant bias with radiologists reporting higher grades. Despite high kappa values, disagreement between raters was not infrequent and most common for grades II-IV.
VCUG is reliable for grading VUR, but small differences in grading between raters were detected and may play an important role in clinical decision-making and research outcomes.
排尿性膀胱尿道造影(VCUG)是用于膀胱输尿管反流(VUR)管理的常用影像学检查。最近,VCUG对VUR进行准确分级的可靠性受到质疑。本研究的目的是在繁忙的儿科医院模拟日常实践的环境中,检验VCUG对VUR分级的可靠性。
由两名儿科泌尿科医生和两名儿科放射科医生根据国际膀胱输尿管反流分类标准,对连续200例VCUG进行独立分级。计算加权kappa系数以确定评分者间的一致性,并进行改良的McNemar检验以评估评分者偏差。针对II级和III级之间的差异,进一步评估其对临床和研究决策的影响。
加权kappa值反映出泌尿科医生和放射科医生之间及内部对VCUG进行VUR分级具有高度可靠性,范围为0.95至0.97。放射科医生报告的分级较高,存在统计学上的显著偏差。尽管kappa值较高,但评分者之间的差异并不罕见,最常见于II-IV级。
VCUG对VUR分级是可靠的,但检测到评分者之间的分级存在微小差异,这可能在临床决策和研究结果中起重要作用。