MP51-06 A CALL TO DISCONTINUE THE USE OF FLOW SHAPES IN PEDIATRIC UROFLOWMETRY

Abstract

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-06 A CALL TO DISCONTINUE THE USE OF FLOW SHAPES IN PEDIATRIC UROFLOWMETRY Jason Van Batavia, Hans Pohl, Walid Farhat, George Chiang, Ahmad Bani Hani, Therese Collett-Gardere, and Israel Franco Jason Van BataviaJason Van Batavia More articles by this author , Hans PohlHans Pohl More articles by this author , Walid FarhatWalid Farhat More articles by this author , George ChiangGeorge Chiang More articles by this author , Ahmad Bani HaniAhmad Bani Hani More articles by this author , Therese Collett-GardereTherese Collett-Gardere More articles by this author , and Israel FrancoIsrael Franco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Uroflow curves are read on a regular basis and are considered an essential tool in the evaluation and management of patients with voiding dysfunction. Unfortunately, the actual inter-rater reliability is poor in many instances. Our aim was to investigate what the inter-rater reliability (IRR) is among 5 disparate reviewers without any relationship in their training pedigree. METHODS: We obtained deidentified uroflow curves from 5 centers which were read by 5 seasoned pediatric urologists with different training backgrounds. 1 reviewer and his NP reviewed studies separately to assess the effect of similar pedigrees. All flow data was recorded, and the readings were all recorded for each curve and then a Fleiss inter rater kappa was generated for the group. The similar pedigree 2 person readers also were scored as well using the fleiss IR kappa. Descriptive statistics were generated on all the data along with subgrouping based on the flow curve shapes along with the sex. RESULTS: We reviewed 405 studies from females who averaged 9.3 yrs and 121 studies from males who were 10.6 yrs. When shapes are defined by the Q avg flow index based on the cutoffs of <=0.67 for plateau and >=1.33 for tower we see the following rates of agreement. We saw very low IRR as evidenced by the Fleiss Kappa for these studies as outlined in the tables above. The best result was obtained by using the Qavg flow index to describe the flow characteristics where we were able to obtain a kappa of 0.773. This finding clearly demonstrates what we learned from discriminant analysis which picks Qavg FI as the dominant characteristic to define shapes as well. CONCLUSIONS: It is quite clear that a kappa of 0.156 is indicative of very poor IRR between disparate seasoned pediatric urologists who all have different pedigrees with regards to training. These findings contradict other studies where personnel trained in the same center have relatively good kappa’s and substantiates the finding of the recent paper by Netto et al where in a global survey the IRR was poor. The fact that the kappa for the shape based on a cut off of 1 S.D. below and above the Q avg flow index has a kappa of 0.773 represents a much better way to define uroflowmetry and substantiates our call to abandon the use of the arbitrarily defined flow shapes which are incapable of consistent reading across disparate readers. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e898-e898 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Van Batavia More articles by this author Hans Pohl More articles by this author Walid Farhat More articles by this author George Chiang More articles by this author Ahmad Bani Hani More articles by this author Therese Collett-Gardere More articles by this author Israel Franco More articles by this author Expand All Advertisement Loading ...