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Effectiveness of percutaneous vesico-amniotic shunting in congenital lower urinary tract obstruction : divergence in prior beliefs among specialist groups
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Brown, Celia A., Morris, R. Katie, Daniels, Jane, Khan, Khalid S., Lilford, Richard and Kilby, Mark D. (2010) Effectiveness of percutaneous vesico-amniotic shunting in congenital lower urinary tract obstruction : divergence in prior beliefs among specialist groups. European Journal of Obstetrics & Gynecology and Reproductive Biology, 152 (1). pp. 25-29. doi:10.1016/j.ejogrb.2010.04.019
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Official URL: http://dx.doi.org/10.1016/j.ejogrb.2010.04.019
Abstract
Objective:
To explore the prior beliefs regarding the effectiveness of percutaneous vesico-amniotic shunting in congenital lower urinary tract obstruction among different clinical specialist groups involved in caring for this condition.
Study design:
Questionnaire survey of experts in the field based on principles of Bayesian elicitation of prior beliefs. The sample was 59 consultants in three specialties. Of these, 37 (63%) were subspecialty trained fetal medicine practitioners, 16 (27%) were paediatric nephrologists and 6 (10%) were paediatric urologists. The questionnaire elicited experts’ opinions as to: control arm perinatal mortality, effect of vesico-amniotic shunting on perinatal mortality, current clinical practice and the level of evidence required to change current practice.
Results:
The response rates were 28% for fetal medicine specialists, 29% for paediatric nephrolgists and 10% for paediatric urologists. The median belief for fetal medicine specialists was a 10% (inter-quartile range, IQR 0–20%) reduction in perinatal mortality with shunting and a mean control arm perinatal mortality of 61%. For paediatric nephrologists the results were 5% (IQR −10 to 15%) and 18% and for paediatric urologists 10% (IQR 0–15%) and 17%. Fetal medicine specialists had the most optimistic beliefs regarding effect of shunting on perinatal mortality. Thirty-eight experts (68%) indicated that vesico-amniotic shunting would most likely reduce morbidity associated with renal dysfunction.
Conclusion:
The prior beliefs show a divergence of opinion among specialists. This establishes clinical equipoise, which should be resolved with a randomised trial.
| Item Type: | Journal Article | ||||||||
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Journal or Publication Title: | European Journal of Obstetrics & Gynecology and Reproductive Biology | ||||||||
| Publisher: | Elsevier Ireland Ltd | ||||||||
| ISSN: | 0301-2115 | ||||||||
| Official Date: | September 2010 | ||||||||
| Dates: |
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| Volume: | 152 | ||||||||
| Number: | 1 | ||||||||
| Page Range: | pp. 25-29 | ||||||||
| DOI: | 10.1016/j.ejogrb.2010.04.019 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access |
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