Department of Urology, University of Minnesota, Minneapolis, MN.
Department of Urology, University of Minnesota, Minneapolis, MN.
Urology. 2021 Feb;148:32-36. doi: 10.1016/j.urology.2020.10.054. Epub 2020 Dec 5.
To create and validate a grading scale that facilitates communication between providers managing gross hematuria (GH).
A blood simulant was used to create a spectrum of GH in 5 foley catheter tubes which were shown to a group of experienced urologists. The urologists were asked how they would adjust the continuous bladder irrigation rate if the samples represented the urine of hypothetical patients, and a 5-point scale was created by group consensus with pictures of the representative tubes printed onto a visual aid. Another cohort were then shown the 5 tubes at random and asked to describe the GH. Raters were then shown the visual aid and asked to assign a grade to the same samples. Fleiss' kappa analysis was used to measure inter-rater agreement, and therefore fidelity of the scale.
Fourteen urologists were surveyed to determine the samples used to create the 5-point scale. After the scale was created, 43 raters (22 nurses, 16 urologists, and 5 advanced practice providers) attempted match the tubes to their corresponding images on the printout. When asked to describe the degree of GH for the samples as they would in clinical practice, 28 different descriptors were used (mean 8.6 per sample). When using the 5-point GH scale, however, raters exhibited near perfect agreement in matching each sample to its corresponding severity on the scale (κ = 0.93, P < .001).
We created a clinically useful GH scale that improves communication and reduces ambiguous language among providers of varying levels of experience.
创建和验证一个分级量表，以促进管理肉眼血尿 (GH) 的提供者之间的沟通。
使用血液模拟物在 5 个 Foley 导管管中创建 GH 谱，然后将这些管展示给一组有经验的泌尿科医生。泌尿科医生被要求如果样本代表假设患者的尿液，他们将如何调整连续膀胱冲洗速度，然后通过小组共识创建一个 5 分制量表，并将代表管的图片打印在视觉辅助工具上。然后，另一组人随机查看这 5 个管，并要求描述 GH。然后向评估者展示视觉辅助工具，并要求他们对相同的样本进行评分。使用 Fleiss' kappa 分析来衡量评分者之间的一致性，从而评估量表的准确性。
调查了 14 名泌尿科医生，以确定用于创建 5 分制量表的样本。在创建量表后，43 名评估者（22 名护士、16 名泌尿科医生和 5 名高级实践提供者）试图将管与打印输出上的相应图像匹配。当被要求根据他们在临床实践中会描述样本的 GH 程度时，使用了 28 个不同的描述符（每个样本平均 8.6 个）。然而，当使用 5 分制 GH 量表时，评估者在将每个样本与量表上的相应严重程度进行匹配方面表现出近乎完美的一致性（κ=0.93，P<.001）。
我们创建了一个在临床上有用的 GH 量表，可改善不同经验水平的提供者之间的沟通，并减少模糊语言。
