PD06-12 INTER- AND INTRA-RATER VARIABILITY OF VIDEOURODYNAMIC STUDY INTERPRETATION AMONG UROLOGIC SURGEONS FOR PATIENTS WITH SPINA BIFIDA

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD06-12 INTER- AND INTRA-RATER VARIABILITY OF VIDEOURODYNAMIC STUDY INTERPRETATION AMONG UROLOGIC SURGEONS FOR PATIENTS WITH SPINA BIFIDA Maria Antony, John K. Weaver, Madalyne Martin-Olenski, Joseph Logan, Reiley Broms, David Ostrowski, Jason Van Batavia, Dana A. Weiss, Christopher J. Long, Ariana L. Smith, Jing Huang, Stephen A. Zderic, Yong Fan, and Gregory E. Tasian Maria AntonyMaria Antony More articles by this author , John K. WeaverJohn K. Weaver More articles by this author , Madalyne Martin-OlenskiMadalyne Martin-Olenski More articles by this author , Joseph LoganJoseph Logan More articles by this author , Reiley BromsReiley Broms More articles by this author , David OstrowskiDavid Ostrowski More articles by this author , Jason Van BataviaJason Van Batavia More articles by this author , Dana A. WeissDana A. Weiss More articles by this author , Christopher J. LongChristopher J. Long More articles by this author , Ariana L. SmithAriana L. Smith More articles by this author , Jing HuangJing Huang More articles by this author , Stephen A. ZdericStephen A. Zderic More articles by this author , Yong FanYong Fan More articles by this author , and Gregory E. TasianGregory E. Tasian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Videourodynamics (VUDS) provides functional insight into bladder storage and micturition, particularly in children with neurogenic bladder who are at risk of upper tract injury. These studies can serve as drivers for both medical and surgical decision-making, as well as intervention escalation. However, VUDS interpretation is at threat of both intra- and inter-observer variability. Efforts exist to improve standardization, but it is unclear the extent to which surgeons’ interpretations vary. In this study, we evaluated variability in interpretation of upper tract deterioration secondary to bladder dysfunction in a sample of children with spina bifida. METHODS: A total of 303 VUDS studies were evaluated from 256 unique patients between 2 months to 28 years of age. An initial pilot study of 10 VUDS studies were assessed by 5 fellowship trained urologists to align on risk stratification criteria of 3 graded categories (mild, moderate, or severe). Criteria considered to assess upper tract deterioration included bladder compliance, elevated detrusor leak point pressure, and detrusor sphincter dyssynergia from pressure volume tracings and fluoroscopy images. Subsequently, 303 VUDS studies were randomized to 5 reviewers such that each study received a minimum of 3 reviews. Intraclass correlation coefficients were used to reliability of average and single raters. Reviewers also reassessed a portion (range: 5-16%) of same studies within 6 months of their first review. Percent agreement was determined for each surgeon between initial and repeat reviews, as well as initial review and group consensus. RESULTS: Among the 303 VUDS studies, single and average raters’ intraclass correlation (ICC) was 0.67(95% CI: 0.62-0.71) and 0.91(95% CI: 0.89-0.92), respectively. At least one reviewer showed disagreement with other reviewers in 37.3% (113/303) of cases. There was a sole case (0.3%, 1/303) in which 3 different risk scores were assigned to the same patient. Among the sample of studies that were reassessed for intrarater reliability, median agreement of a single urologist with their previous risk score was 76.25% (IQR: 68.75-78.525). Median agreement of a single urologist with group consensus was 80.4% (IQR: 75-81.6). CONCLUSIONS: Class reliability trended upwards with raters average compared to a single rater, showing moderate and good reliability respectively. Single rater inter- and intra-rater variation may compound across serial urodynamic evaluation in clinical and research uses of VUDS to evaluate upper tract deterioration. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e160 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Antony More articles by this author John K. Weaver More articles by this author Madalyne Martin-Olenski More articles by this author Joseph Logan More articles by this author Reiley Broms More articles by this author David Ostrowski More articles by this author Jason Van Batavia More articles by this author Dana A. Weiss More articles by this author Christopher J. Long More articles by this author Ariana L. Smith More articles by this author Jing Huang More articles by this author Stephen A. Zderic More articles by this author Yong Fan More articles by this author Gregory E. Tasian More articles by this author Expand All Advertisement PDF downloadLoading ...