Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Pediatr Surg Int. 2024 Aug 19;40(1):233. doi: 10.1007/s00383-024-05816-8.
This study evaluates the inter-rater agreements of both the Glans-Urethral Meatus-Shaft (GMS) hypospadias score and Hypospadias Objective Penile Evaluation (HOPE) score, aiming to standardize disease classification for consistent agreement in clinically relevant characteristics of hypospadias.
Photos of hypospadias in children were collected from two separate institutions. Three raters scored the photos using GMS and HOPE, excluding penile torsion and curvature assessment in HOPE due to photo limitations.
A total of 528 photos were included. With GMS, Fleiss' multi-rater kappa showed an agreement of 0.745 for glans-urethral plate, 0.869 for meatus, and 0.745 for shaft. For HOPE scores, the agreements were 0.888 for position of meatus, 0.669 for shape of meatus, 0.730 for shape of glans, and 0.708 for the shape of the skin. The lower agreement in the shape of the meatus evaluation may be attributed to the lack of a quantitative classification method in HOPE. Experts rely on their subjective judgment based on the provided example photos and their index patient.
While there is high agreement among experts when evaluating hypospadias using the GMS and HOPE scoring criteria, only the position of the meatus achieved nearly perfect agreement highlighting that the current scoring systems entail a subjective element in disease classification.
本研究评估了 Glans-Urethral Meatus-Shaft（GMS）尿道下裂评分和 Hypospadias Objective Penile Evaluation（HOPE）评分的观察者间一致性，旨在标准化疾病分类，以在尿道下裂的临床相关特征方面达成一致的共识。
从两个不同的机构收集了儿童尿道下裂的照片。三位评估者使用 GMS 和 HOPE 对照片进行评分，由于照片的限制，HOPE 中不包括阴茎扭转和弯曲评估。
共纳入 528 张照片。使用 GMS 时，Fleiss 多评估者 κ 显示，在龟头尿道板、尿道口和阴茎干方面的一致性分别为 0.745、0.869 和 0.745。对于 HOPE 评分，尿道口位置的一致性为 0.888，尿道口形状为 0.669，龟头形状为 0.730，皮肤形状为 0.708。尿道口形状评估的一致性较低可能归因于 HOPE 中缺乏定量分类方法。专家们依赖于他们的主观判断，基于提供的示例照片和他们的索引患者。
尽管专家在使用 GMS 和 HOPE 评分标准评估尿道下裂时具有高度的一致性，但只有尿道口的位置达到了近乎完美的一致性，这突出表明当前的评分系统在疾病分类中涉及主观因素。
