Gray Marisa C, Zillioux Jacqueline M, Varda Briony, Herndon C D Anthony, Kurtz Michael P, Chow Jeanne S, Kern Nora G
Department of Urology, University of Virginia, 1300 Jefferson Park Ave, Charlottesville, VA, USA.
Department of Urology, Boston Children's Hospital, 75 Francis St, Boston, MA, USA.
J Pediatr Urol. 2020 Aug;16(4):457.e1-457.e6. doi: 10.1016/j.jpurol.2020.04.025. Epub 2020 Apr 30.
The Urinary Tract Dilation (UTD) system was created to address variability in hydronephrosis grading. It is unknown if or how pediatric urologists are integrating this newer system into practice.
We sought to evaluate the current use of hydronephrosis grading systems, inter-rater reliability (IRR) for individual systems, and management preferences based on degree of hydronephrosis.
A survey was emailed to the Societies for Pediatric Urology listserv. Questions addressed familiarity/preference for various grading systems and respondent confidence in interpretation of hydronephrosis. Three clinical vignettes asked respondents to grade hydronephrosis using their system of choice and report further imaging they would obtain. Descriptive statistics were calculated, and IRR was calculated using a linear-weighted modified Fleiss' kappa test.
Response rate was 43% (n = 138). The majority of respondents used Society for Fetal Urology (SFU) (70%) or UTD (19%) systems. Most favored SFU (58%) or UTD (34%) systems for a unified system. Confidence in own interpretation was higher than confidence in radiologists' reads (median 4.4 vs 3.6, p < 0.001). IRR was substantial for UTD (κ0.68 [0.64-0.71]) and moderate for SFU (κ0.60 [0.52-0.76]). There was notable heterogeneity regarding follow-up imaging for cases. There was no difference in requested follow-up studies between SFU and UTD systems, except for fewer voiding cystourethrogram (VCUG) requests for Case 3 with UTD (28% vs 4%, p = 0.02).
Most pediatric urologists still use SFU rather than the UTD system. There was slightly higher IRR with the UTD system. There was substantial variability in follow-up imaging not related to grading system, except with low grade hydronephrosis.
尿路扩张（UTD）系统旨在解决肾盂积水分级的变异性问题。目前尚不清楚儿科泌尿科医生是否以及如何将这个更新的系统应用于临床实践。
我们旨在评估当前肾盂积水分级系统的使用情况、各系统的评分者间信度（IRR）以及基于肾盂积水程度的管理偏好。
通过电子邮件向儿科泌尿外科学会的邮件列表发送了一份调查问卷。问题涉及对各种分级系统的熟悉程度/偏好以及受访者对肾盂积水解读的信心。三个临床病例要求受访者使用他们选择的系统对肾盂积水进行分级，并报告他们将进行的进一步影像学检查。计算描述性统计数据，并使用线性加权修正的Fleiss' kappa检验计算IRR。
回复率为43%（n = 138）。大多数受访者使用胎儿泌尿外科学会（SFU）（70%）或UTD（19%）系统。对于统一系统，大多数人倾向于SFU（58%）或UTD（34%）系统。对自己解读的信心高于对放射科医生解读的信心（中位数4.4对3.6，p < 0.001）。UTD的IRR较高（κ0.68 [0.64 - 0.71]），SFU的IRR中等（κ0.60 [0.52 - 0.76]）。病例的后续影像学检查存在显著异质性。SFU和UTD系统之间在要求的后续研究方面没有差异，除了UTD系统对病例3的排尿性膀胱尿道造影（VCUG）要求较少（28%对4%，p = 0.02）。
大多数儿科泌尿科医生仍使用SFU而非UTD系统。UTD系统的IRR略高。除了轻度肾盂积水外，与分级系统无关的后续影像学检查存在很大变异性。
