Department of Urology, Boston Children's Hospital and Harvard Medical School , Boston , Massachusetts.
Department of Radiology, Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio.
J Urol. 2019 Jun;201(6):1186-1192. doi: 10.1097/JU.0000000000000026.
The Urinary Tract Dilation classification system was designed to be more objective and reproducible than currently available grading systems. We evaluated the reliability and consistency of the system in newborns.
Of 1,046 infants 0 to 90 days old undergoing ultrasound for hydronephrosis 243 were randomly selected for study inclusion. Seven readers (4 radiologists and 3 urologists) at 4 institutions classified complete, de-identified ultrasound studies on a Web based platform. Interobserver and intra-observer agreement was evaluated using the Fleiss kappa statistic.
Interobserver agreement for Urinary Tract Dilation risk score was moderate among the 7 readers (kappa = 0.421, 95% CI 0.404-0.438). Interobserver agreement using the Society for Fetal Urology scale was worse than with the Urinary Tract Dilation classification (kappa = 0.344, 95% CI 0.330-0.359). All 7 readers assigned the same Urinary Tract Dilation score in 19.3% of cases (47 of 243). In 38.7% of cases (94 of 243) at least 3 readers assigned a Urinary Tract Dilation score different from that assigned by the other readers. In 7% of cases (17 of 243) at least 3 readers assigned a score of P0/P1, while at least 3 readers scored the same cases as P2/P3. At least 3 different Urinary Tract Dilation risk scores were assigned to the same patient in 30.45% of patients (74 of 243). Among individual Urinary Tract Dilation elements calyceal dilatation and bladder status had the highest disagreement. Five readers regraded 80 cases and agreed with their previous Urinary Tract Dilation risk score in 63.8% to 75.0% of cases (kappa 0.458 to 0.729).
Interobserver agreement using the Urinary Tract Dilation grading system is fair to moderate, with variable agreement on individual elements of the system. Agreement was higher for the Urinary Tract Dilation system compared to the Society for Fetal Urology scale.
与现有的分级系统相比，尿路扩张分类系统旨在更客观、更具可重复性。我们评估了该系统在新生儿中的可靠性和一致性。
在因肾积水而接受超声检查的 1046 名 0 至 90 天龄婴儿中，随机选择 243 名婴儿进行研究。4 家机构的 7 名读者（4 名放射科医生和 3 名泌尿科医生）在基于网络的平台上对完整的、去识别的超声研究进行分类。使用 Fleiss kappa 统计评估观察者间和观察者内的一致性。
7 名读者对尿路扩张风险评分的观察者间一致性为中度（kappa = 0.421，95%CI 0.404-0.438）。使用胎儿泌尿外科学会（Society for Fetal Urology）分级的观察者间一致性差于尿路扩张分类（kappa = 0.344，95%CI 0.330-0.359）。所有 7 名读者在 19.3%的病例（243 例中的 47 例）中分配了相同的尿路扩张评分。在 38.7%的病例（243 例中的 94 例）中，至少有 3 名读者分配的尿路扩张评分与其他读者不同。在 7%的病例（243 例中的 17 例）中，至少有 3 名读者分配了 P0/P1 评分，而至少有 3 名读者将相同的病例评为 P2/P3。在 30.45%的患者（243 例中的 74 例）中，至少 3 种不同的尿路扩张风险评分被分配给同一患者。在单独的尿路扩张因素中，肾盏扩张和膀胱状态的分歧最大。5 名读者重新对 80 例进行分级，在 63.8%至 75.0%的病例中与他们之前的尿路扩张风险评分一致（kappa 0.458 至 0.729）。
使用尿路扩张分级系统的观察者间一致性为中等至尚可，系统的各个元素存在差异。与胎儿泌尿外科学会分级相比，该系统的一致性更高。
