VARIATION IN THE DIAGNOSIS OF VESICOURETERAL REFLUX USING MICTURATINGCYSTOURETHROGRAPHY

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 int erpretation. Three experienced paediatric radiologists from the same d epartment independently interpreted the MCUs according to the grading system of the International Reflux Study in Children, from grades O to V, with the presence of intrarenal reflux also noted. Apart from bein g informed that urine infection was the indication for the MCU, no oth er clinical information was given to the radiologists. The indices of variability used were the percentage of agreement and the kappa statis tic, expressed as a percentage. Both measures were weighted with integ ers representing the number of categories from perfect agreement. Disa greement was analysed for children and kidneys. For the diagnosis of v esicoureteric reflux in individual patients, including grade, the perc entage of agreement was 96%-97% (kappa 90%-91%) and the weighted perce ntage of agreement was 96%-98% (weighted kappa 93%-94%). The same high level of agreement was present for individual kidneys, with a percent age of agreement of 97%-98% (kappa 89%-92%) and a weighted percentage of agreement of 98%-99% (kappa 94%-95%). There was near perfect agreem ent in the interpretation of radiological micturating cystourethrograp hy among three experienced paediatric radiologists for the diagnosis a nd grade of vesicoureteric reflux. Any variations in the medical care of children suspected of having vesicoureteric reflux are not explaine d by differences in the reporting of this diagnostic test.