Goel Prabudh, Choudhury Prativa, Verma Vivek, Phugat Shivani, Kalaivani Mani, Singh Teg Rabab, Sharma Kanika, Jain Vishesh, Yadav Devendra Kumar, Dhua Anjan Kumar, Agarwala Sandeep
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Statistics, Assam University, Silchar, Assam, India.
J Indian Assoc Pediatr Surg. 2024 Nov-Dec;29(6):579-588. doi: 10.4103/jiaps.jiaps_107_24. Epub 2024 Nov 5.
A discrepancy between the true and measured value of stretched penile length (SPL) may be a result of errors that can either be systematic or random. Hence, it becomes important to focus on the quality of measurements to prevent any iatrogenic harm to the patients.
The objective of this study was to assess the magnitude of intra- and interobserver variations in the measurement of SPL with the SPLINT technique.
SPL was measured prospectively in a cohort of 449 boys aged 0-14 years including 68 infants (substratified into Group I: >4 years, Group II: 4-8 years, and Group III: >8 years) with the SPLINT technique by expert (E: E1 and E2) and trainee (T: T1 and T2) surgeons after completing a three-tiered training module. Intra- and interobserver variability was assessed through descriptive statistics, intraclass correlation (ICC), relative technical error of measurement (rTEM), and reliability or (%).
Intraobserver variability: the mean difference between the two readings (E1 and E2) is 0.08 cm (95% confidence interval [CI]: 0.073-0.087), ICC was 0.998 (95% CI: 0.997-0.998), and intraobserver variability ≤0.1 cm in 85% of the participants ( = 370 of 433). The rTEM and reliability (%) were 1.82% and 98.1% (Group I), 1.65% and 98.9% (Group II), and 1.09% and 99.7% (Group III), respectively. The intraobserver variability was observed to be inversely proportional to the age of the participants (correlation coefficient = -0.56). Interobserver variability was calculated separately for expert versus trainee and trainee versus trainee (T-vs-T) measurements. For expert versus expert, ICC, rTEM, and reliability (%) were 0.984, 2.4%, and 96.8% (Group 1), 0.992, 2.07%, and 98.3% (Group 2), and 0.997, 1.38%, and 99.05% (Group 3), respectively. A similar pattern of variability was observed for T-vs-T measurements. The reliability (%) of the SPL by experts is consistently more than that of trainees across all age groups; however, the difference ameliorates with the age of participant.
The study has validated the SPLINT technique by demonstrating a high level of intra- and interobserver reliability. The adequacy of the training modules for SPL measurements described in this study has also been established. Evidence that the SPL can be used as an objective marker of penile dimensions is herewith furnished.
阴茎拉伸长度（SPL）的真实值与测量值之间的差异可能是由系统误差或随机误差导致的。因此，关注测量质量以防止对患者造成任何医源性伤害变得至关重要。
本研究的目的是评估使用SPLINT技术测量SPL时观察者内和观察者间变异的程度。
采用SPLINT技术对449名0至14岁男孩进行前瞻性SPL测量，其中包括68名婴儿（分为I组：大于4岁，II组：4至8岁，III组：大于8岁），由专家（E：E1和E2）和实习医生（T：T1和T2）在完成三级培训模块后进行测量。通过描述性统计、组内相关系数（ICC）、相对测量技术误差（rTEM）和可靠性或（%）评估观察者内和观察者间的变异性。
观察者内变异性：两次读数（E1和E2）之间的平均差异为0.08厘米（95%置信区间[CI]：0.073 - 0.087），ICC为0.998（95%CI：0.997 - 0.998），85%的参与者（433名中的370名）观察者内变异性≤0.1厘米。rTEM和可靠性（%）在I组分别为1.82%和98.1%，II组为1.65%和98.9%，III组为1.09%和99.7%。观察到观察者内变异性与参与者年龄成反比（相关系数 = -0.56）。分别计算专家与实习医生以及实习医生与实习医生（T对T）测量的观察者间变异性。对于专家与专家，ICC、rTEM和可靠性（%）在I组分别为0.984、2.4%和96.8%，II组为0.992、2.07%和98.3%，III组为0.997、1.38%和99.05%。T对T测量也观察到类似的变异模式。在所有年龄组中，专家测量的SPL可靠性（%）始终高于实习医生；然而，随着参与者年龄的增长，差异有所改善。
本研究通过证明高水平的观察者内和观察者间可靠性验证了SPLINT技术。本研究中描述的SPL测量培训模块的充分性也已得到证实。由此提供了SPL可作为阴茎尺寸客观指标的证据。
