Int Neurourol J.  2017 Apr;21(Suppl 1):S66-S75. 10.5213/inj.1734854.427.

Development of Decision Support Formulas for the Prediction of Bladder Outlet Obstruction and Prostatic Surgery in Patients With Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia: Part II, External Validation and Usability Testing of a Smartphone App

• Choo MS
• Jeong SJ
• Cho SY
• Yoo C
• Jeong CW
• Ku JH
• Oh SJ

• KMID: 2378440
• DOI: http://doi.org/10.5213/inj.1734854.427

Abstract

PURPOSE
We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO) and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing.
METHODS
Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app.
RESULTS
A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179) and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues.
CONCLUSIONS
External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue.

Keyword

Decision Support Systems, Clinical; Nomograms; Validation Studies; Predictive Values of Tests; Mobile Apps

MeSH Terms

Calibration
Cohort Studies
Dataset
Decision Support Systems, Clinical
Discrimination (Psychology)
Humans
Mobile Applications
Nomograms
Prostatic Hyperplasia*
Sensitivity and Specificity
Seoul
Smartphone*
Tertiary Care Centers
Urinary Bladder Neck Obstruction*
Urinary Bladder*
Urinary Tract*