Confidence In Interpretation Research Articles

Ischemic ECG Pattern Recognition to Facilitate Interpretation While Task Switching: A Parallel Curriculum.

IntroductionInterruptions are an inevitable part of working as an emergency physician, yet these can increase cognitive load and precipitate medical error. Emergency physicians learn to balance these responsibilities using a process called task switching. Yet residents have little exposure to exercises that purposefully integrate task switching during their training. We addressed this gap by exposing emergency medicine (EM) trainees to task-switching events in the form of critical ECG interpretation while they were engaged in concurrent, parallel activities.MethodsThe curriculum was carried out in three phases. First, 12 PGY 2 residents engaged in a small-group session testing their baseline confidence and ECG interpretation skills. The second phase was longitudinal: During concurrent educational activities, investigators interrupted tasks and asked trainees to interpret ECGs in 10 seconds or less. The curriculum's final phase was used to review the ECGs and answer any questions.ResultsConfidence and percentage of correct interpretations were compared from phase 1 to phase 2. Participants showed improved confidence (M = 2.5, SD = 0.6, to M = 2.9, SD = 0.6; p = .02; 5-point Likert scale) and increased mean percent correct (M = 0.7, SD = 0.1, to M = 0.8, SD = 0.1; p = .01) following the curriculum.DiscussionOur curriculum provides a pragmatic, reproducible approach to enhancing critical ECG interpretation with task switching in a way that mirrors the EM practice environment, promoting a reduction of cognitive load and highlighting the skills learners will need as they develop expertise.

Reassessment of causality of ABCC6 missense variants associated with pseudoxanthoma elasticum based on Sherloc

PurposePseudoxanthoma elasticum (PXE) is a heritable disorder affecting elastic fibers in the skin, eyes, and cardiovascular system. It is caused by biallelic pathogenic variants in the ABCC6 gene. To date, over 300 ABCC6 variants are associated with PXE, more than half being missense variants. Correct variant interpretation is essential for establishing a direct link between the variant and the patient’s phenotype and has important implications for diagnosis and treatment. MethodsWe used a systematic approach for interpretation of 271 previously reported and 15 novel ABCC6 missense variants, based on the semiquantitative classification system Sherloc. ResultsOnly 35% of variants were very likely to contribute directly to disease, in contrast to reported interpretations in ClinVar, while 59% of variants are currently of uncertain significance (VUS). Subclasses were created to distinguish VUS that are leaning toward likely benign or pathogenic, increasing the number of (likely) pathogenic ABCC6 missense variants to 47%. ConclusionBesides highlighting discrepancies between the Sherloc, American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG-AMP), ClinVar, and Leiden Open Variation Database (LOVD) classification, our results emphasize the need for segregation analysis, functional assays, and detailed evidence sharing in variant databases to reach a confident interpretation of ABCC6 missense variants and subsequent appropriate genetic and preconceptual counseling.

GeLC-Orbitrap/MS and 2-DE-MALDI-TOF/TOF comparative proteomics analysis of seed cotyledons from the non-orthodox Quercus ilex tree species

Gel electrophoresis-based and shotgun approaches are the most employed proteomic platforms in plant biology research, with the latter replacing the former in the last years. We have compared 2-DE-MALDI-TOF/TOF and GeLC-Orbitrap/MS analyses using the same protein extracts from Quercus ilex cotyledons at different development stages. The results obtained (ProteomeXchange available data, PXD020603) showed that both platforms were complementary, showing common and specific proteins identified in each case, but leading to similar biological conclusions. Protein analysis identified 562 spots in gel-based (292 variables) and 2409 proteins in shotgun (560 variables), that were detected with both platforms and represent common key pathways related to maturation and germination. The main differences concern hormone metabolism, storage and late embryogenesis abundant proteins. Deeper proteome coverage was obtained with the shotgun approach, with a greater number of metabolic pathways represented, as gibberellin biosynthesis, not observed in the gel-based analysis. Nevertheless, several storage proteins, highly abundant in cotyledons and well represented in gel-based platform were not identified using the shotgun platform. These results support that when analyzing any plant biological process, the use of both platforms is complementary rather than redundant, that favors an in-depth proteomic analysis and a more confident biological interpretation of the data obtained.

Prospective Consensus Reporting by Gynecologic Pathology and Dermatopathology Improves Diagnosis of Vulvar Biopsies.

Vulvar biopsy interpretation and reporting, particularly of vulvar dermatoses, can be challenging in daily practice for both surgical pathologists (SPs) and dermatopathologists (DPs). To investigate whether prospective consensus reporting of vulvar biopsies by SPs and DPs would provide value and improve overall diagnostic concordance. Consecutive vulvar biopsies during a 6-month period were reviewed prospectively by both gynecologic SPs and DPs. Preliminary, independently generated diagnoses were recorded and then shared in consensus review (SPs+DPs). A third pathologist adjudicated cases without consensus. Multiple data elements were collected for each case: division (SP/DP), age, site, clinical history, diagnostic category, preliminary and final (consensus) diagnosis, need for adjudication, ancillary tests, and diagnostic discrepancy. Eighty-four biopsies (48 SP, 36 DP) from 70 patients were reviewed. Forty-two of 84 cases (50%) were neoplastic, 38 of 84 (45%) were reactive/inflammatory, with the remaining (5%) showing both or other features. Independent diagnoses were discrepant in 22 of 84 cases (26%), but consensus review resulted in an agreed-upon diagnosis in all cases, with adjudication required in 6 cases. Independent diagnostic agreement increased over time with a reduction in major and minor discrepancies between the first and second half of the study period. Prospective review of vulvar biopsies by both SPs and DPs can improve overall reporting. Consensus review allows pathologists to gain diagnostic confidence in interpretation of inflammatory (for SPs) and neoplastic (for DPs) vulvar biopsies; therefore, intradepartmental consultation is of value, particularly in select cases.

Online Learning and Echocardiography Boot Camp: Innovative Learning Platforms Promoting Blended Learning and Competency in Pediatric Echocardiography.

Mastering pediatric echocardiography (PE) requires a substantial knowledge base of echo theory and congenital heart disease (CHD), along with technical proficiency. Online self-directed learning has become increasingly utilized among medical trainees to promote competency within medical subspecialties. We sought to evaluate the impact of online learning combined with lecture-based and hands-on teaching on the acquisition of PE knowledge and confidence in pediatric cardiology and pediatric critical care fellows. We prospectively enrolled 124 learners from 2016 to 2019. These included 40 incoming cardiology and critical care fellows at Texas Children's Hospital (TCH) as well as 84 national and international participants recruited from our online echo education website. All participants completed online learning modules through our website ( www.pedecho.org ), which covers pediatric echo physics, Doppler, technique, normal anatomy, atrial septal defects, and ventricular septal defects. TCH cardiology and critical care fellows subsequently participated in an Echo Boot Camp (BC), a 3-day training program with hands-on workshops and didactic lectures. Knowledge was assessed using an 80-question pre and post-test multiple choice exams. The online learning group demonstrated improvement in exam scores following online learning (PRE 49.1 ± 15.3 vs. POST 67.8 ± 17%; p ≤ 0.01). Echo Boot Camp fellows were noted to have further incremental improvement in test scores following BC (PRE 48% ± 13% vs. POST MODULE 68.6% ± 15% vs. POST BC 75.7% ± 13%; p ≤ 0.01). Self-assessment regarding confidence in context areas showed a substantial gain in self perceived interpretive confidence across all groups as well as procedural confidence in BC participants. Online learning significantly promotes the acquisition of echocardiography knowledge. Additional lecture-based and hands-on teaching in the form of an Echo Boot Camp can further enhance knowledge and interpretative skills. Both of these learning platforms appear to work in concert as powerful and effective tools in fellow education.

Interactive e-Learning Electrocardiogram Module: Increasing Confidence and Interpretation Ability Among Family Nurse Practitioner Students.

Electrocardiogram (ECG) interpretation is a skill that family nurse practitioners (FNPs) use almost daily in primary care. One way to teach ECG interpretation in a flexible way is through e-learning modules. The purpose of this study was to evaluate the confidence and ability of ECG interpretation in FNP students who completed a series of e-learning modules. Student confidence and ability to correctly identify ECGs increased after completing the series (p < .0001). Adding self-paced modules such as this one into an FNP curriculum will likely be invaluable for students' future clinical careers.

Clinician and computer: a study on patient perceptions of artificial intelligence in skeletal radiography

BackgroundUp to half of all musculoskeletal injuries are investigated with plain radiographs. However, high rates of image interpretation error mean that novel solutions such as artificial intelligence (AI) are being...

How Old Is the Hebrew Bible? A Linguistic, Textual, and Historical Study

How Old Is the Hebrew Bible? A Linguistic, Textual, and Historical Study

Validation of a Novel Cutaneous Neoplasm Diagnostic Self-Efficacy Instrument (CNDSEI) for Evaluating User-Perceived Confidence With Dermoscopy.

Accurate medical image interpretation is an essential proficiency for multiple medical specialties, including dermatologists and primary care providers. A dermatoscope, a ×10-×20 magnifying lens paired with a light source, enables enhanced visualization of skin cancer structures beyond standard visual inspection. Skilled interpretation of dermoscopic images improves diagnostic accuracy for skin cancer. Design and validation of Cutaneous Neoplasm Diagnostic Self-Efficacy Instrument (CNDSEI)-a new tool to assess dermatology residents' confidence in dermoscopic diagnosis of skin tumors. In the 2018-2019 academic year, the authors administered the CNDSEI and the Long Dermoscopy Assessment (LDA), to measure dermoscopic image interpretation accuracy, to residents in 9 dermatology residency programs prior to dermoscopy educational intervention exposure. The authors conducted CNDSEI item analysis with inspection of response distribution histograms, assessed internal reliability using Cronbach's coefficient alpha (α) and construct validity by comparing baseline CNDSEI and LDA results for corresponding lesions with one-way analysis of variance (ANOVA). At baseline, residents respectively demonstrated significantly higher and lower CNDSEI scores for correctly and incorrectly diagnosed lesions on the LDA (P = 0.001). The internal consistency reliability of CNDSEI responses for the majority (13/15) of the lesion types was excellent (α ≥ 0.9) or good (0.8≥ α <0.9). The CNDSEI pilot established that the tool reliably measures user dermoscopic image interpretation confidence and that self-efficacy correlates with diagnostic accuracy. Precise alignment of medical image diagnostic performance and the self-efficacy instrument content offers opportunity for construct validation of novel medical image interpretation self-efficacy instruments.

Transmission Electron Microscopy of the Retina: A Method for Sample Preparation and Evaluation.

Ultrastructural pathology is critical in the morphologic evaluation and characterization of subcellular structures in nonclinical toxicity and efficacy studies. In murine models of ophthalmologic disease, clinical examination is typically paired with other techniques like electroretinography (ERG) and/or optical coherence tomography (OCT) to more fully characterize a finding. High-quality transmission electron microscopy (TEM) can provide a critical, image-based link between these approaches, providing greater confidence in interpretation of ERG or OCT results. In addition to characterization of disease models, TEM can provide detailed visualization of retinal changes identified by clinical examination or light microscopy in nonclinical toxicity studies. The spherical shape of the eye presents unique challenges for trimming, orientation, imaging, and evaluation by TEM. The varied components of the eye require specialized approaches for embedding to facilitate successful sectioning. Controlling for the orientation of the retina is critical to consistent evaluation, driving the need for an improved method of embedding this unique and complex organ. The authors describe a method of sample preparation resulting in optimal orientation of the posterior aspect of murine eyes (rat and mouse) for TEM of the neural retina, Bruch's membrane and/or choroid, with examples from mouse ophthalmic disease models.

Impact of ion suppression by sample cap liners in lipidomics

Contamination from the polymeric material released by vial caps used for sample introduction in liquid chromatography can significantly affect the signal of the analyte of interest. In particular, repeated injections from the same sample vial can enhance this suppressing effect. Multiple injections of the same sample are often used in metabolomics and lipidomics during routine analyses. Here we demonstrate how the presence of contaminant polymers, originating from the vial closures, significantly influences the estimation of the relative amount of endogenous lipids in human plasma. Furthermore, this can negatively impact other operations in mass spectrometric analysis, such as instrument equilibration and tuning or the common use of technical replicates to improve confidence in data interpretation. Our observations provide critical information on how to improve future analyses through the use of appropriate vial caps, solvents, chromatographic separations and equipment.

Affine analysis for quantitative PCR measurements.

Motivated by the current COVID-19 health crisis, we consider data analysis for quantitative polymerase chain-reaction (qPCR) measurements. We derive a theoretical result specifying the conditions under which all qPCR amplification curves (including their plateau phases) are identical up to an affine transformation, i.e. a multiplicative factor and horizontal shift. We use this result to develop a data analysis procedure for determining when an amplification curve exhibits characteristics of a true signal. The main idea behind this approach is to invoke a criterion based on constrained optimization that assesses when a measurement signal can be mapped to a master reference curve. We demonstrate that this approach: (i) can decrease the fluorescence detection threshold by up to a decade; and (ii) simultaneously improve confidence in interpretations of late-cycle amplification curves. Moreover, we demonstrate that the master curve is transferable reference data that can harmonize analyses between different labs and across several years. Application to reverse-transcriptase qPCR measurements of a SARS-CoV-2 RNA construct points to the usefulness of this approach for improving confidence and reducing limits of detection in diagnostic testing of emerging diseases. Graphical Left: a collection of qPCR amplification curves. Right: Example of data collapse after affine transformation.

A Hierarchical Mentoring Program Increases Confidence and Effectiveness in Data Analysis and Interpretation for Undergraduate Biology Students.

Science instructors are increasingly incorporating teaching techniques that help students develop core competencies such as critical-thinking and communication skills. These core competencies are pillars of career readiness that prepare undergraduate students to successfully transition to continuing education or the workplace, whatever the field. Course-based undergraduate research experiences that culminate in written research papers can be effective at developing critical-thinking and communication skills but are challenging to implement as class size (and student-to-instructor ratio) grows. We developed a hierarchical mentoring program in which graduate student mentors guided groups of four to five undergraduate students through the scientific process in an upper-level ecology course. Program effectiveness was evaluated by grading final research papers (including previous year papers, before the program was implemented) and surveys (comparing to a course that did not implement the program). Results indicated that primary benefits of hierarchical mentoring were improvements in perceived and demonstrated ability in data analysis and interpretation, leading to a median increase in paper score of ∼10% on a 100-point scale. Future directions indicated by our study were a need to incorporate more approaches (e.g., low-stakes writing exercises) and resources into a revised program to improve outcomes for students whose primary language is not English.

Emotion recognition and confidence ratings predicted by vocal stimulus type and prosodic parameters

Human speech expresses emotional meaning not only through semantics, but also through certain attributes of the voice, such as pitch or loudness. In investigations of vocal emotion recognition, there is considerable variability in the types of stimuli and procedures used to examine their influence on emotion recognition. In addition, accurate metacognition was argued to promote correct and confident interpretations in emotion recognition tasks. Nevertheless, such associations have rarely been studied previously. We addressed this gap by examining the impact of vocal stimulus type and prosodic speech attributes on emotion recognition and a person’s confidence in a given response. We analysed a total of 1038 emotional expressions according to a baseline set of 13 prosodic acoustic parameters. Results showed that these parameters provided sufficient discrimination between expressions of emotional categories to permit accurate statistical classification. Emotion recognition and confidence judgments were found to depend on stimulus material as they could be reliably predicted by different constellations of acoustic features. Finally, results indicated that listeners’ accuracy and confidence judgements were significantly higher for affect bursts than speech-embedded stimuli and that the correct classification of emotional expressions elicited increased confidence judgements. Together, these findings show that vocal stimulus type and prosodic attributes of speech strongly influence emotion recognition and listeners’ confidence in these given responses.

Effectiveness of High-Fidelity Simulation in Training Emergency Medicine Physicians in Point of Care Ultrasonography in Pakistan: A Quasi-Experimental Study.

BackgroundPoint-of-care ultrasound (PoCUS) is frequently utilized in emergency medicine (EM), with an extended-focused assessment with sonography in trauma (e-FAST) being the most widely used PoCUS modality. This modality is not only time- and cost-efficient, but it is highly accurate in the diagnosis and management of surgical patients in the emergency department, as well as being highly predictive of patient outcomes. Targeted training is essential to ensure a learner's confidence in image acquisition, interpretation, and translation of knowledge to making clinical decisions. High-fidelity simulation offers a uniquely safe and "mistake-forgiving" environment to teach and train medical professionals. The present study evaluated the effectiveness of a high-fidelity simulator to train EM physicians in e-FAST at a tertiary care teaching hospital in a lower-middle-income country.MethodsThis quasi-experimental study was performed at a state-of-the-art simulation center of a multidisciplinary university hospital in Karachi, Pakistan. Subjects were included if they were EM physicians who volunteered to participate and were available for the entire training and testing period. The educational intervention included lectures and hands-on practice on a high-fidelity simulator (SonoSim, Santa Monica, CA).Knowledge and image interpretation on e-FAST were evaluated using a questionnaire, administered before and after the training course. Each participant's ability to acquire and interpret satisfactory images was assessed by experienced EM physicians and recorded. Participants were also administered a needs assessment survey and a course evaluation. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). All the tests were two-sided, and p-values ≤0.05 were considered significant. Baseline characteristics and outcome variables were recorded and compared by Wilcoxon signed-rank tests.ResultsA total of 31 EM physicians, 12 (38.7%) men and 19 (61.3%) women, were enrolled in the study, with 24 (77.3%) having one to three years of EM experience. Mean and percentage group performance improved from 6 and 40% before the intervention to 14.5 and 96.6% after the intervention (Z=4.867, p≤0.05). Most improvement in image acquisition on high-fidelity simulation was observed in the upper right quadrant of the suprapubic window (29/31; 93.5%), followed by the upper left quadrant (27/31; 87%) and the subxiphoid window (21/31; 67%). All 31 participants reported improvements in comfort and confidence level with PoCUS after attending the workshop.ConclusionsEM physicians who attended a brief workshop incorporating simulation demonstrated improvements in knowledge and image acquisition skills in all domains tested. High-fidelity simulation training is an effective modality for training EM physicians in e-FAST.

Interpretable confidence measures for decision support systems

Decision support systems (DSS) have improved significantly but are more complex due to recent advances in Artificial Intelligence. Current XAI methods generate explanations on model behaviour to facilitate a user's understanding, which incites trust in the DSS. However, little focus has been on the development of methods that establish and convey a system's confidence in the advice that it provides. This paper presents a framework for Interpretable Confidence Measures (ICMs). We investigate what properties of a confidence measure are desirable and why, and how an ICM is interpreted by users. In several data sets and user experiments, we evaluate these ideas. The presented framework defines four properties: 1) accuracy or soundness, 2) transparency, 3) explainability and 4) predictability. These characteristics are realized by a case-based reasoning approach to confidence estimation. Example ICMs are proposed for -and evaluated on- multiple data sets. In addition, ICM was evaluated by performing two user experiments. The results show that ICM can be as accurate as other confidence measures, while behaving in a more predictable manner. Also, ICM's underlying idea of case-based reasoning enables generating explanations about the computation of the confidence value, and facilitates user's understandability of the algorithm. © 2020 The Authors

Neurofilaments: neurobiological foundations for biomarker applications.

Interest in neurofilaments has risen sharply in recent years with recognition of their potential as biomarkers of brain injury or neurodegeneration in CSF and blood. This is in the context of a growing appreciation for the complexity of the neurobiology of neurofilaments, new recognition of specialized roles for neurofilaments in synapses and a developing understanding of mechanisms responsible for their turnover. Here we will review the neurobiology of neurofilament proteins, describing current understanding of their structure and function, including recently discovered evidence for their roles in synapses. We will explore emerging understanding of the mechanisms of neurofilament degradation and clearance and review new methods for future elucidation of the kinetics of their turnover in humans. Primary roles of neurofilaments in the pathogenesis of human diseases will be described. With this background, we then will review critically evidence supporting use of neurofilament concentration measures as biomarkers of neuronal injury or degeneration. Finally, we will reflect on major challenges for studies of the neurobiology of intermediate filaments with specific attention to identifying what needs to be learned for more precise use and confident interpretation of neurofilament measures as biomarkers of neurodegeneration.

Screening for atrial fibrillation and other arrhythmias in primary care

BackgroundAtrial fibrillation (AF) and other arrhythmias are prevalent and often encountered by general practitioners (GPs). In response to the growing prevalence and to assist practitioners in the diagnosis and management of AF, the Cardiac Society of Australia & New Zealand and Heart Foundation of Australia published the first Australian AF Guidelines in 2018. We aimed to examine (a) the proportion of GPs who performed any form of AF screening and identify the methods they applied, (b) GPs’ awareness of the AF Guidelines and approaches to arrhythmia screening, (c) the roles of conventional 12-lead ECG and mobile health devices, and (d) GPs’ confidence in ECG interpretation and need for training.MethodsA cross-sectional online survey titled “GPs Screen their patients for Atrial Fibrillation and othEr aRrhythmia (GPSAFER)” was conducted from October 2018 to March 2019. The participants were recruited via various GP networks across Australia. Ethics approval was granted by The University of Sydney.ResultsA total of 463 surveys were completed. Many GPs (394/463, 85.1%, 95% CI 81.5–88.2%) performed some forms of AF screening and applied at least one AF screening method, most frequently pulse palpation (389/463, 84.0%). Some (299/463, 64.6%) GPs considered assessing their patients for other arrhythmias (237/299, 79.3% for complete heart block and 236/299, 78.9% for long-QT). Most GPs (424/463, 91.6%) were not using mobile ECG devices in their practice but some (147/463, 31.7%) were contemplating it. One third (175/463, 37.8%) of GPs were aware of the Australian AF Guidelines; those aware were more likely to perform AF screening (98.9% vs 76.7%, p < 0.001). Factors significantly and positively associated with AF screening were “awareness of the AF Guidelines” (p < 0.001), “number of years working in general practice” (p < 0.001), and “confidence in ECG interpretation of AF” (p = 0.003). Most GPs reported that they were very or extremely confident in interpreting AF (381/463, 82.3%) and complete heart block (266/463, 57.5%). Many GPs (349/463, 75.4%) would like to receive online ECG interpretation training.ConclusionsAssessment of arrhythmias is common in general practice and GPs are open to further training in ECG interpretation and using mobile ECG devices to aid their clinical practice. Increasing awareness of AF Guidelines and improving confidence in ECG interpretation may increase AF screening.

P048: Brief online educational intervention improves emergency physicians’ and general surgeon's ability to interpret focused gallbladder ultrasound

Introduction: Biliary colic is a frequent cause for emergency department visits. Ultrasound is the initial test of choice for gallstone disease. We evaluated the effectiveness of a brief online educational module aimed to improve Emergency Physicians’ (EP) and General Surgeons’ (GS) accuracy in interpreting gallbladder ultrasound. Methods: EPs and GSs (resident/fellow and attending) from a single academic tertiary care hospital were invited to participate in a pre- and post- assessment of the interpretation of gallbladder ultrasound. Demographic information was obtained in a standardized survey. All questions developed for the pre- and post- assessment were reviewed for content and clarity by 3 EP and GS experts. Participants were asked 22 multiple-choice questions and then directed to a 7-minute video-tutorial on gallbladder ultrasound interpretation. After a 3-week period, participants then completed a post-intervention assessment. Following pre- and post- assessment, participants were surveyed on their confidence in gallbladder ultrasound interpretation. Data was analyzed using descriptive statistics and paired t-test. Results: The overall response rate of the pre-intervention was 50.9% (116/228) and 40.8% (93/228) for the post-intervention. In pre-intervention assessment, 27.7% of participants reported they were “not at all confident” in interpreting gallbladder ultrasound. This contrasted with post-intervention confidence level, where only minority (7.8%) reported “not at all confident”. There was a significant increase from the pre- to post- intervention (75.7% to 85.4%; p &lt; 0.01) in correct interpretations. The greatest improvement was seen in those with previous experience interpreting gallbladder ultrasound (from 79.6% to 91.1%; p &lt; 0.01). EPs scored significantly higher than GSs in the pre-intervention (EPs 78.2% compared to GSs 71.0%; p &lt; 0.01). This trend was also observed in post-intervention, although the difference was no longer significant (EPs 88.9% compared to GSs 82.8%; p = 0.05). There was no significant difference in performance between residents/fellows compared to attendings. Conclusion: This brief, online intervention improved the accuracy of EPs’ and GSs’ interpretation of gallbladder ultrasound. This is an easily accessible tutorial that can be used as part of a comprehensive ultrasound educational program. Further studies are required to determine if EPs’ and GSs’ interpretations of gallbladder ultrasound impacts patient-oriented outcomes.

Assessment of urinary tract dilation grading amongst pediatric urologists

The Urinary Tract Dilation (UTD) system was created to address variability in hydronephrosis grading. It is unknown if or how pediatric urologists are integrating this newer system into practice. We sought to evaluate the current use of hydronephrosis grading systems, inter-rater reliability (IRR) for individual systems, and management preferences based on degree of hydronephrosis. A survey was emailed to the Societies for Pediatric Urology listserv. Questions addressed familiarity/preference for various grading systems and respondent confidence in interpretation of hydronephrosis. Three clinical vignettes asked respondents to grade hydronephrosis using their system of choice and report further imaging they would obtain. Descriptive statistics were calculated, and IRR was calculated using a linear-weighted modified Fleiss' kappa test. Response rate was 43% (n=138). The majority of respondents used Society for Fetal Urology (SFU) (70%) or UTD (19%) systems. Most favored SFU (58%) or UTD (34%) systems for a unified system. Confidence in own interpretation was higher than confidence in radiologists' reads (median 4.4 vs 3.6, p<0.001). IRR was substantial for UTD (κ0.68 [0.64-0.71]) and moderate for SFU (κ0.60 [0.52-0.76]). There was notable heterogeneity regarding follow-up imaging for cases. There was no difference in requested follow-up studies between SFU and UTD systems, except for fewer voiding cystourethrogram (VCUG) requests for Case 3 with UTD (28% vs 4%, p=0.02). Most pediatric urologists still use SFU rather than the UTD system. There was slightly higher IRR with the UTD system. There was substantial variability in follow-up imaging not related to grading system, except with low grade hydronephrosis.