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Observer variation in assessing renal scarring

E W Fletcher, G J Griffiths, L A Williams

    The British Journal of Radiology
    |May 1, 1980
    PubMed
    Summary
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    Experienced radiologists showed high agreement in identifying renal scarring on intravenous urograms. This suggests reliable detection of kidney scarring in pediatric bacteriuria cases.

    Area of Science:

    • Radiology
    • Pediatric Nephrology

    Background:

    • Renal scarring is a key complication of childhood urinary tract infections.
    • Accurate identification of renal scarring is crucial for patient management and epidemiological studies.

    Purpose of the Study:

    • To quantify inter-observer agreement among experienced radiologists in detecting renal scarring.
    • To assess the reliability of intravenous urography for diagnosing renal scarring in schoolgirls with bacteriuria.

    Main Methods:

    • Three radiologists independently reviewed 60 intravenous urograms from schoolgirls with bacteriuria.
    • Observers classified renal scarring as absent, doubtful, or present at three specific kidney sites.
    • Agreement was measured using overall proportion and the kappa statistic.

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    Main Results:

    • Overall agreement ranged from 86% to 89%.
    • Kappa values, correcting for chance agreement, were between 0.67 and 0.73.
    • These kappa values indicate substantial to almost perfect agreement, exceeding levels reported for other radiological assessments and adult renal scarring.

    Conclusions:

    • High inter-observer agreement was achieved in recognizing renal scarring on intravenous urograms in this pediatric cohort.
    • Findings suggest intravenous urography is a reliable tool for detecting renal scarring in this population.
    • Future prevalence studies should incorporate multiple experienced observers to account for any remaining variation.