title: Interrater Reliability in Pediatric Urodynamic Tracings: A Pilot Study.
abstract: Urodynamic studies are crucial to neuropathic bladder management and they often determine surgical intervention. However, current evidence indicates that interpretations show poor agreement across physicians. We sought to determine the interrater reliability of urodynamic interpretation in our practice. We hypothesized that there would be strong correlation among pediatric urologists of similar training in a single academic practice.
  
  
  
  We retrospectively identified patients with neuropathic bladder who underwent urodynamics at our institution between 2014 and 2015. An anonymous electronic survey (phase I) was developed with 20 clinical scenarios, each containing a brief history, a single urodynamic tracing and an accompanying fluoroscopic image. Faculty members assessed each tracing by an online instrument developed using urodynamic reports and published literature. The primary outcome was statistical correlation across raters as measured by the Spearman correlation coefficient. In a followup study (phase II) we investigated the sources of variability in urodynamic interpretations.
  
  
  
  Six faculty members completed the study with a response rate of 100%. In comparing urodynamic interpretation across raters, the faculty demonstrated a weak to strong correlation (rs0.39-0.61, p <0.001). A strong correlation was found for fluoroscopic and clinical decision making variables, while electromyography synergy and detrusor overactivity demonstrated weaker correlation across physicians.
  
  
  
  Faculty interpretations of urodynamic tracings showed only moderate agreement despite a close working relationship and similar training at a single institution. Variability in interpretation can strongly impact patient treatment. Therefore, further work is needed to standardize the reporting and interpretation of urodynamic studies to optimize patient care.
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. Electronic address: annedudleymd@gmail.com.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Dudley
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Casella
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Chelsea J
authors.initials: CJ
authors.lastname: Lauderdale
authors.affiliation: Center for Quantitative Science, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Shilin
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Center for Quantitative Science, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Heidi
authors.initials: H
authors.lastname: Chen
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Stacy T
authors.initials: ST
authors.lastname: Tanaka
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: John C
authors.initials: JC
authors.lastname: Thomas
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: John C
authors.initials: JC
authors.lastname: Pope
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Adams
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: John W
authors.initials: JW
authors.lastname: Brock
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Chevis N
authors.initials: CN
authors.lastname: Shannon
authors.affiliation: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Douglass B
authors.initials: DB
authors.lastname: Clayton
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010372:Pediatrics; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology*; D014563:Urodynamics; D014572:Urology
keywords: neurogenic; observer variation; reproducibility of results; urinary bladder; urodynamics; urologists