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Assessment of Interobserver Reliability of Nephrologist Examination of Urine Sediment.

ABSTRACT: Importance:Urine sediment microscopy is commonly performed during the evaluation of kidney disease. Interobserver reliability of nephrologists' urine sediment examination has not been well studied. Objective:Assess interobserver reliability of the urine sediment examination. Design, Setting, and Participants:In this diagnostic test study, urine samples were prospectively collected from a convenience sample of adult patients from an academic hospital in the United States undergoing kidney biopsy from July 11, 2018, to March 20, 2019. Digital images and videos of urine sediment findings were captured using a bright-field microscope. These images and videos along with urine dipstick results were incorporated in online surveys and sent to expert nephrologists at 15 US teaching hospitals. They were asked to identify individual sediment findings and the most likely underlying disease process. Exposures:Urine dipstick results and urine sediment images from patients undergoing native kidney biopsy. Main Outcomes and Measures:Interobserver reliability of urine sediment microscopy findings estimated by overall percent agreement and Fleiss ? coefficients. Secondary outcomes included concordance of diagnoses suspected by nephrologists with corresponding kidney biopsy results. Results:In total, 10 surveys from 10 patients containing 76 study questions on individual features were sent to 21 nephrologists, 14 (67%) of whom completed them all. Their combined 1064 responses were analyzed. Overall percent agreement for casts was an estimated 59% (95% CI, 50%-69%), ??=?0.52 (95% CI, 0.42-0.62). For other sediment findings, overall percent agreement was an estimated 69% (95% CI, 61%-77%), ??=?0.65 (95% CI, 0.56-0.73). The ? estimates ranged from 0.13 (95% CI, 0.10-0.17) for mixed cellular casts to 0.90 (95% CI, 0.87-0.94) for squamous epithelial cells. Conclusions and Relevance:In this study, substantial variability occurred in the interpretation of urine sediment findings, even among expert nephrologists. Educational or technological innovations may help improve the urine sediment as a diagnostic tool.

SUBMITTER: Palsson R

PROVIDER: S-EPMC7442930 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Assessment of Interobserver Reliability of Nephrologist Examination of Urine Sediment.

Palsson Ragnar R Colona Mia R MR Hoenig Melanie P MP Lundquist Andrew L AL Novak James E JE Perazella Mark A MA Waikar Sushrut S SS

JAMA network open 20200803 8

<h4>Importance</h4>Urine sediment microscopy is commonly performed during the evaluation of kidney disease. Interobserver reliability of nephrologists' urine sediment examination has not been well studied.<h4>Objective</h4>Assess interobserver reliability of the urine sediment examination.<h4>Design, setting, and participants</h4>In this diagnostic test study, urine samples were prospectively collected from a convenience sample of adult patients from an academic hospital in the United States und ...[more]

PMID: 32821922

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Project description:IntroductionClinicians rely on certain physical examination tests to diagnose and potentially grade ankle sprains and ankle instability. Diagnostic error and inaccurate prognosis may have important repercussions for clinical decision-making and patient outcomes. Therefore, it is important to recognize the diagnostic value of orthopaedic tests through understanding the reliability and validity of these tests.ObjectiveTo systematically review and report evidence on the reliability and validity of orthopaedic tests for the diagnosis of ankle sprains and instability.MethodsPubMed, CINAHL, Scopus, and Cochrane databases were searched from inception to December 2021. In addition, the reference list of included studies, located systematic reviews, and orthopaedic textbooks were searched. All articles reporting reliability or validity of physical examination or orthopaedic tests to diagnose ankle instability or sprains were included. Methodological quality of the reliability and the validity studies was assessed with The Quality Appraisal for Reliability studies checklist and the Quality Assessment of Diagnostic Accuracy Studies-2 respectively. We identified the number of times the orthopaedic test was investigated and the validity and/or reliability of each test.ResultsOverall, sixteen studies were included. Three studies assessed reliability, eight assessed validity, and five evaluated both. Overall, fifteen tests were evaluated, none demonstrated robust reliability and validity scores. The anterolateral talar palpation test reported the highest diagnostic accuracy. Further, the anterior drawer test, the anterolateral talar palpation, the reverse anterior lateral drawer test, and palpation of the anterior talofibular ligament reported the highest sensitivity. The highest specificity was attributed to the anterior drawer test, the anterolateral drawer test, the reverse anterior lateral drawer test, tenderness on palpation of the proximal fibular, and the squeeze test.ConclusionOverall, the diagnostic accuracy, reliability, and validity of physical examination tests for the assessment of ankle instability were limited. Physical examination tests should not be used in isolation, but rather in combination with the clinical history to diagnose an ankle sprain. Preliminary evidence suggests that the overall validity of physical examination for the ankle may be better if conducted five days after the injury rather than within 48 h of injury.

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Assessment of Interobserver Reliability of Nephrologist Examination of Urine Sediment.

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Assessment of Interobserver Reliability of Nephrologist Examination of Urine Sediment.

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