Interrater Reliability in Pediatric Urodynamic Tracings: A Pilot Study

Dudley, Anne; Casella, Daniel P.; Lauderdale, Chelsea J.; Zhao, Shilin; Chen, Heidi; Tanaka, Stacy T.; Thomas, John C.; Pope, John C.; Adams, Mark C.; Brock, John W.; Shannon, Chevis N.; Clayton, Douglass B.

doi:10.1016/j.juro.2016.10.053

Cited by 32 publications

(17 citation statements)

References 11 publications

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“…Furthermore, patients with high pressure bladders began an early treatment with CIC and anticholinergic drugs, which may have favored a better outcome. Finally, a study by Dudley et al showed that there exists a considerable variation between examiners in the performance of urodynamic studies, which may render different results (57).…”

Section: Risk Factors -Urodynamic Parametersmentioning

confidence: 99%

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

Sager¹,

Barroso

Bastos

et al. 2022

Int. braz j urol.

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Introduction: Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children. Materials and Methods: Five Pediatric Urologists joined a group of experts and reviewed all important issues on "Spina Bifi da, Neurogenic Bladder in Children" and elaborated a draft of the document. All the members of the group focused on the same system of classifi cation of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document. Results and Discussion: The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the fi rst days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to fi rst-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.

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Section: Risk Factors -Urodynamic Parametersmentioning

confidence: 99%

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

Sager¹,

Barroso

Bastos

et al. 2022

Int. braz j urol.

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“…This becomes even more challenging if the formal interpretation of the tracing is left until after the urodynamics session is completed. As shown in several studies, and in an interactive presentation by Dr. Stacy Tanaka at the 2017 Spina Bifida Association meeting, the interpretation of the cystometrogram after the fact only increases the chances for greater inter-observer variability and possible intra-observer variability as well(1). In addition, after one has performed hundreds of studies, how can one begin to categorize the subsets of patients without looking at each record?…”

Section: Introductionmentioning

confidence: 99%

Using structured data entry systems in the electronic medical record to collect clinical data for quality and research: Can we efficiently serve multiple needs for complex patients with spina bifida?

Batavia

Weiß

Long

et al. 2018

PRM

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Purpose: The era of the electronic health record (ERH) generates the ability to systematically collect and record innumerable data for complex procedures such as videourodynamic studies (VUDS). We developed a Structured Data Entry System (SDES) that would serve as a way to better standardize VUDS for both quality improvement and research capabilities. Methods: A working group convened to design a SDES form for VUDS in a flow sheet format in our hospital’s EHR, allowing for easy integration of the information into the clinical encounter note and for a weekly export of data to clinicians in spreadsheet form. Results: Analysis of weekly VUDS data revealed that entries were missing in 3% of cells in all SDES forms completed. The availability of the data in an Excel spreadsheet allows for easy manipulation, calculation of clinical variables, and streamlined analysis in figures or graphs to identify patients at the highest risk. Conclusion: Designing and implementing a SDES based on a flowsheet that can allow data to seamlessly be placed in the clinical record and to be integrated into a searchable database for quality improvement and research purposes, allows one to harness the true potential of the EHR.

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“…Overall, the clinical utility of UDS relies on the production of high-quality data that can be reproducibly interpreted between investigators. A 2017 study found weak inter-rater reliability in identifying detrusor overactivity and electromyographic synergy in children 17 . This finding echoes concerns regarding inter-rater reliability and protocol consistency in the ICS's Good Urodynamic Practice guideline 2 , which notes that this issue is not an inherent problem of the measurement itself but is rather a result of the current limitations of UDS equipment and the lack of a consensus on the precise method of measurement, signal processing, quantification, documentation and interpretation.…”

Section: Reproducibility and Standardizationmentioning

confidence: 99%

“…UDS is also used in certain paediatric urology scenarios, particularly in monitoring risk of renal deterioration in patients with neurogenic LUTD 17 . In 2015, the ICCS published guidelines for the use of UDS in children 16 .…”

Section: Current Trends In Urodynamicsmentioning

confidence: 99%

Ambulatory urodynamic monitoring: state of the art and future directions

et al. 2019

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Urodynamic studies are a key component of the clinical evaluation of lower urinary tract dysfunction and include filling cystometry, pressure-flow studies, uroflowmetry, urethral function tests and electromyography. However, pitfalls of traditional urodynamics include physical and emotional discomfort, artificial test conditions with catheters and rapid retrograde filling of the bladder, which result in variable diagnostic accuracy. Ambulatory urodynamic monitoring (AUM) uses physiological anterograde filling and, therefore, offers a longer and more physiologically relevant evaluation. However, AUM methods rely on traditional catheters and pressure transducers and do not measure volume continuously, which is required to provide context for pressure changes. Novel telemetric AUM (TAUM) methods that use wireless, catheter-free, batterypowered devices to monitor bladder pressure and volume while patients carry out their daily activities are currently being investigated. TAUM devices under current development are innovating in the areas of remote monitoring, rechargeable energy sources, device deployment and retrieval and materials engineering to provide increased diagnostic accuracy and improved comfort * damasem@ccf.org. Author contributions Competing interests S.M. and M.S.D. are co-inventors on a patent titled 'Implantable Pressure Sensor' (US 10,143,391 B2), which might be perceived as a competitive technology to those described in this paper. This patent is assigned jointly to the Cleveland Clinic, Case Western Reserve University and the US Department of Veterans Affairs. It has not been licensed or optioned by a company. Additional related intellectual property with S.M. and M.

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Interrater Reliability in Pediatric Urodynamic Tracings: A Pilot Study

Cited by 32 publications

References 11 publications

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

Using structured data entry systems in the electronic medical record to collect clinical data for quality and research: Can we efficiently serve multiple needs for complex patients with spina bifida?

Ambulatory urodynamic monitoring: state of the art and future directions

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