Abstract：
OBJECTIVE: Vesicoureteral reflux (VUR) grade has been used as a primary factor in assessing a child\'s risk of clinical outcomes. Unfortunately, grade has poor inter-observer reliability. We hypothesized that more objective and reliable VCUG parameters including the distal ureteral diameter ratio (UDR) and volume at onset of VUR (Vol) may either augment or replace the current grading system to provide more reliable prediction of clinical outcomes.
METHODS: Multivariate clinical outcome models were analyzed to assess the impact on predictive accuracy by the addition of voiding cystourethrogram (VCUG) data including grade, UDR, and Vol, alone or in combinations. Clinical variables from retrospective review of 841 children\'s records included age, gender, presentation, VUR laterality, bowel and bladder dysfunction, history of febrile urinary tract infection (UTI), and number of UTIs. The primary outcomes assessed included VUR resolution or persistence and need for operative intervention.
RESULTS: Grade, UDR, and Vol were independent predictors of resolution and operative intervention. Vol increased predictive accuracy in resolution models with grade or UDR alone; however, no significant difference occurred in models with the substitution of grade with UDR.
CONCLUSIONS: A more reliable classification system for VUR, with improved predictive accuracy regarding clinical outcomes, may be developed incorporating UDR and Vol. Whether VUR grade can be completely replaced by Vol and UDR measurements requires further evaluation with larger number of patients.
METHODS: Multivariate clinical outcome models were analyzed to assess the impact on predictive accuracy by the addition of voiding cystourethrogram (VCUG) data including grade, UDR, and Vol, alone or in combinations. Clinical variables from retrospective review of 841 children\'s records included age, gender, presentation, VUR laterality, bowel and bladder dysfunction, history of febrile urinary tract infection (UTI), and number of UTIs. The primary outcomes assessed included VUR resolution or persistence and need for operative intervention.
RESULTS: Grade, UDR, and Vol were independent predictors of resolution and operative intervention. Vol increased predictive accuracy in resolution models with grade or UDR alone; however, no significant difference occurred in models with the substitution of grade with UDR.
CONCLUSIONS: A more reliable classification system for VUR, with improved predictive accuracy regarding clinical outcomes, may be developed incorporating UDR and Vol. Whether VUR grade can be completely replaced by Vol and UDR measurements requires further evaluation with larger number of patients.
摘要：
目的：膀胱输尿管反流（VUR）等级已被用作评估儿童临床结局风险的主要因素。不幸的是,等级的观察者间可靠性较差。我们假设更客观和可靠的VCUG参数，包括输尿管远端直径比（UDR）和VUR开始时的体积（Vol）可以增强或取代当前的分级系统，以提供更可靠的临床结果预测。
方法：分析了多变量临床结果模型，以评估通过增加排尿膀胱尿道造影（VCUG）数据对预测准确性的影响，包括分级，UDR,和卷，单独或组合。来自841名儿童记录的回顾性回顾的临床变量包括年龄，性别,介绍,VUR侧向性，肠和膀胱功能障碍，发热性尿路感染（UTI）史，和UTI的数量。评估的主要结果包括VUR消退或持久性以及手术干预的需要。
结果：成绩，UDR,和Vol是解决和手术干预的独立预测因子。Vol提高了单独使用等级或UDR的分辨率模型的预测准确性；然而，在用UDR代替等级的模型中没有显着差异。
结论：VUR更可靠的分类系统，提高了临床结果的预测准确性，可以结合UDR和Vol开发。VUR等级是否可以完全由Vol和UDR测量代替，需要对更多患者进行进一步评估。
方法：分析了多变量临床结果模型，以评估通过增加排尿膀胱尿道造影（VCUG）数据对预测准确性的影响，包括分级，UDR,和卷，单独或组合。来自841名儿童记录的回顾性回顾的临床变量包括年龄，性别,介绍,VUR侧向性，肠和膀胱功能障碍，发热性尿路感染（UTI）史，和UTI的数量。评估的主要结果包括VUR消退或持久性以及手术干预的需要。
结果：成绩，UDR,和Vol是解决和手术干预的独立预测因子。Vol提高了单独使用等级或UDR的分辨率模型的预测准确性；然而，在用UDR代替等级的模型中没有显着差异。
结论：VUR更可靠的分类系统，提高了临床结果的预测准确性，可以结合UDR和Vol开发。VUR等级是否可以完全由Vol和UDR测量代替，需要对更多患者进行进一步评估。
