Interobserver and Intra-Observer Reliability of the Urinary Tract Dilation Classification System in Neonates: A...

Area of Science:

• Pediatric Urology
• Medical Imaging Analysis
• Radiology

Background:

• Current grading systems for urinary tract dilation (UTD) lack objectivity and reproducibility.
• Reliable classification of UTD in newborns is crucial for appropriate management and follow-up.
• The newly developed UTD classification system aims to improve upon existing methods.

Purpose of the Study:

• To evaluate the interobserver and intra-observer reliability and consistency of the Urinary Tract Dilation (UTD) classification system in newborns.
• To compare the reliability of the UTD classification system with the Society for Fetal Urology (SFU) scale.

Main Methods:

• A total of 243 infants (0-90 days old) with hydronephrosis were randomly selected from 1,046 infants.
• Seven readers (4 radiologists, 3 urologists) from 4 institutions classified de-identified ultrasound studies using a web-based platform.
• Interobserver and intra-observer agreement were assessed using the Fleiss kappa statistic.

Main Results:

• Interobserver agreement for the UTD risk score was moderate (kappa = 0.421).
• The UTD system demonstrated better interobserver agreement (kappa = 0.421) compared to the SFU scale (kappa = 0.344).
• Disagreement was noted in individual UTD elements, particularly calyceal dilatation and bladder status.

Conclusions:

• The UTD classification system exhibits fair to moderate interobserver agreement in newborns.
• The UTD system shows improved reliability over the SFU scale for grading hydronephrosis.
• Variable agreement on specific UTD elements suggests areas for potential system refinement.