UCI Dept. Urology/CHOC Children's Urology, 505 S. Main St. Suite 100 Orange, CA, 92828, USA.
UCI Health Policy Research Institute 100 Theory, Suite 100 Irvine, CA 92617, USA.
J Pediatr Urol. 2020 Jun;16(3):367-370. doi: 10.1016/j.jpurol.2020.03.007. Epub 2020 Mar 19.
Bladder trabeculation (BT) is commonly noted on cystogram images of patients with neurogenic bladder (NB). BT is associated with a hostile bladder often requiring prompt, more aggressive management. We aimed to define and validate a reliable grading system for BT severity. The proposed grading system will improve clinicians and radiologist's communication and serve as a foundation for future studies in the field of NB. The study was conducted in two phases: 1) Development of a grading system for BT and 2) testing of the proposed grading system for reliability and validity. Agreement between raters was assessed using Cohen's Kappa. Inter-rater reliability and intra-rater reliability was assessed using intra-class correlation coefficients (ICC) and Spearman's p (rho) correlation coefficient. The content of the grading system was assessed for face validity by senior pediatric urology and radiology experts. We observed inter-rater reliability with ICC of 0.998 (95%CI 0.996-0.999, p < 0.001), and a Cohen's Kappa ranging from 0.795 to 1.0, p < 0.001 and Spearman's p (rho) correlation coefficient ranging from 0.910 to 1.0, p < 0.001 between raters on the decided grades of BT. In conclusion, we established a defined grading system for BT severity that has substantial inter/intra-rater reliability and validity. This grading system could be useful for improving clinician and radiologist's communication about the status of a child's bladder wall and serve as a foundation for future studies assessing severity of NB.
膀胱小梁化（BT）在神经源性膀胱（NB）患者的膀胱造影图像中很常见。BT 与敌对的膀胱有关，通常需要及时、更积极的治疗。我们旨在定义和验证 BT 严重程度的可靠分级系统。拟议的分级系统将改善临床医生和放射科医生之间的沟通，并为 NB 领域的未来研究奠定基础。该研究分两个阶段进行：1）制定 BT 分级系统；2）测试拟议的分级系统的可靠性和有效性。使用 Cohen 的 Kappa 评估评分者之间的一致性。使用组内相关系数（ICC）和 Spearman 的 p（rho）相关系数评估组内和组间的可靠性。通过资深儿科泌尿科医生和放射科医生对分级系统的内容进行了表面有效性评估。我们观察到组间可靠性的 ICC 为 0.998（95%CI 0.996-0.999，p<0.001），Cohen 的 Kappa 范围为 0.795 至 1.0，p<0.001，Spearman 的 p（rho）相关系数范围为 0.910 至 1.0，p<0.001，评分者对 BT 分级的决定等级之间存在相关性。总之，我们建立了一个用于 BT 严重程度的明确分级系统，具有很强的组内/间可靠性和有效性。该分级系统可用于改善临床医生和放射科医生关于儿童膀胱壁状况的沟通，并为未来评估 NB 严重程度的研究奠定基础。
