OBJECTIVE
To create and validate a grading scale that facilitates communication between providers
managing gross hematuria (GH).
METHODS
A blood simulant was used to create a spectrum of GH in 5 foley catheter tubes which
were shown to a group of experienced urologists. The urologists were asked how they
would adjust the continuous bladder irrigation rate if the samples represented the
urine of hypothetical patients, and a 5-point scale was created by group consensus
with pictures of the representative tubes printed onto a visual aid. Another cohort
were then shown the 5 tubes at random and asked to describe the GH. Raters were then
shown the visual aid and asked to assign a grade to the same samples. Fleiss’ kappa
analysis was used to measure inter-rater agreement, and therefore fidelity of the
scale.
RESULTS
Fourteen urologists were surveyed to determine the samples used to create the 5-point
scale. After the scale was created, 43 raters (22 nurses, 16 urologists, and 5 advanced
practice providers) attempted match the tubes to their corresponding images on the
printout. When asked to describe the degree of GH for the samples as they would in
clinical practice, 28 different descriptors were used (mean 8.6 per sample). When
using the 5-point GH scale, however, raters exhibited near perfect agreement in matching
each sample to its corresponding severity on the scale (κ = 0.93, P < .001).
CONCLUSION
We created a clinically useful GH scale that improves communication and reduces ambiguous
language among providers of varying levels of experience.
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Article info
Publication history
Published online: December 04, 2020
Accepted:
October 13,
2020
Received:
August 5,
2020
Footnotes
Declarations of Interest: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
