Interrater Reliability in Interpretation of Neuropathic Pediatric Urodynamic Tracings: An Expanded Multi-Center Study

Dudley, A. G.; Adams, M. C.; Brock, J. W., 3rd; Clayton, D. B.; Joseph, D. B.; Koh, C. J.; Merguerian, P. A.; Pope, J. C. th; Routh, J. C.; Thomas, J. C.; Tu, D. D.; Wallis, M. C.; Wiener, J. S.; Yerkes, E. B.; Lauderdale, C. J.; Shannon, C. N.; Tanaka, S. T.

J Urol. 2018 Jan 2

Abstract

INTRODUCTION: and Objectives: Urodynamics often guide treatment of neuropathic bladder and are reported as objective data points in multi-institutional trials. Urodynamic interpretation, however, can be variable. In a pilot study, pediatric urologists interpreting videourodynamics (VUDS) showed only moderate agreement despite similar training and practice patterns. We hypothesized the pilot study variability would be replicated in a multi-institutional study. METHODS: We developed an anonymous electronic survey that contained twenty scenarios, each with a brief patient history, one urodynamic tracing and fluoroscopic image. All VUDS were completed during routine care of patients with neuropathic bladder at a single institution. Pediatric urologists from the CDC Urologic Protocol sites were invited to complete an interpretation instrument for each scenario. Fleiss kappa and 95% confidence limits were reported where Fleiss kappa of 1.00 corresponds to perfect agreement. RESULTS: The survey was completed by 14 pediatric urologists at 7 institutions. Substantial agreement was seen for assessment of fluoroscopic bladder shape (fleiss kappa 0.73), while moderate agreement was observed for assessment of bladder safety, end-fill detrusor pressure and bladder capacity (fleiss kappa 0.50; 0.56; 0.54 respectively). Fair agreement was seen for EMG synergy and presence of detrusor overactivity (fleiss kappa 0.21; 0.35 respectively). CONCLUSIONS: Experienced pediatric urologists demonstrate variability during interpretation of VUDS tracings. The subjectivity of assessment of EMG activity and detrusor overactivity was confirmed in this expanded study. Future work to improve the reliability of VUDS interpretation would improve the quality of clinical care, and the multi-institutional studies that utilize urodynamic data points as outcomes.; Key of Definitions for Abbreviations: VUDS (Video Urodynamics); CDC (Centers for Disease Control); EMG (Electromyography); REDCap (Research Electronic Data Capture); Detrusor Leak Point Pressure (DLPP).

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