Variation in the diagnosis of vesicoureteric reflux using micturating cystourethrography |
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| Authors: | Jonathan C Craig Les M Irwig James Christie Albert Lam Ella Onikul John F Knight Premala Sureshkumar L Paul Roy |
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| Institution: | (1) Centre for Kidney Research, New Children’s Hospital, Sydney, Australia, AU;(2) Department of Radiology, New Children’s Hospital, Sydney, Australia, AU;(3) Department of Public Health, University of Sydney, Sydney, Australia, AU |
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| Abstract: | Variability in the interpretation of micturating cystourethrography by paediatric radiologists for the diagnosis of vesicoureteric
reflux in children was evaluated. All 265 micturating cystourethrograms (MCUs) that were available from 304 consecutive children
aged 0.5 – 61 months – who were investigated after their first urine infection between 1993 and 1995 as part of a prospective
cohort study – were selected for interpretation. Three experienced paediatric radiologists from the same department independently
interpreted the MCUs according to the grading system of the International Reflux Study in Children, from grades 0 to V, with
the presence of intrarenal reflux also noted. Apart from being informed that urine infection was the indication for the MCU,
no other clinical information was given to the radiologists. The indices of variability used were the percentage of agreement
and the kappa statistic, expressed as a percentage. Both measures were weighted with integers representing the number of categories
from perfect agreement. Disagreement was analysed for children and kidneys. For the diagnosis of vesicoureteric reflux in
individual patients, including grade, the percentage of agreement was 96% – 97% (kappa 90% – 91%) and the weighted percentage
of agreement was 96% – 98% (weighted kappa 93% – 94%). The same high level of agreement was present for individual kidneys,
with a percentage of agreement of 97% – 98% (kappa 89% – 92%) and a weighted percentage of agreement of 98% – 99% (kappa 94% – 95%).
There was near perfect agreement in the interpretation of radiological micturating cystourethrography among three experienced
paediatric radiologists for the diagnosis and grade of vesicoureteric reflux. Any variations in the medical care of children
suspected of having vesicoureteric reflux are not explained by differences in the reporting of this diagnostic test.
Received June 19, 1996; received in revised form November 1, 1996; accepted December 6, 1996 |
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| Keywords: | : Vesicoureteric reflux Micturating cystourethrogram Observer variation Urinary tract infection |
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