Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management
Intra- and interobserver agreement among obstetric experts in court regarding the review of abnormal fetal heart rate tracings and obstetrical management
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DOI：
10.1016/j.ajog.2015.08.066
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发表时间：
2015-12-01
影响因子：
9.8
通讯作者：
Carcopino, Xavier
中科院分区：
文献类型：
--
作者：
Sabiani, Laura;Le Du, Renaud;Carcopino, Xavier
目的：本研究的目的是评估法庭产科专家在回顾性审查异常胎心率追踪和临产期间胎心率异常患者的产科管理方面的内部和观察者之间的一致性。 研究设计：法庭上共有 22 名法国产科专家审查了 30 例被诊断为至少 1 小时异常胎心率的足月单胎妊娠病例，其中 10 例新生儿结局不良。专家们在 3 个月的时间内对所有病例进行了两次审查，第一次审查对新生儿结局不知情。对于每个审查的案例，专家都获得了产科数据以及完整胎心率记录和产程图的副本。专家们被要求对异常胎心率追踪进行分类，并表达他们是否同意所进行的产科管理。当专家们不同意时，他们被问及是否得出结论认为存在错误，以及是否认为产科管理是儿童脑瘫的原因（如果有的话）。 结果：与盲法审查相比，专家们在得知新生儿结局后更可能同意所进行的产科管理（P < .001）和分娩方式（P < .001），并且不太可能得出结论认为存在错误（P < .001）。 .001）或与潜在的脑瘫建立联系（P = .003）。专家们对于异常胎心率追踪和产科管理的审查的观察者内部一致性均中等（分别为 kappa = 0.46-0.51 和 kappa = 0.48-0.53）。观察者间对异常胎心率追踪的审查一致性较低，并且并未因了解新生儿结局而得到改善（kappa = 0.11-0.18）。观察者间对产科管理解释的一致性也较低（kappa = 0.08-0.19），但似乎通过了解新生儿结局而有所改善（kappa = 0.15-0.32）。 结论：法庭上产科专家之间对于异常胎心率追踪和产科护理适当性审查的内部和观察者间一致性较差，表明产科专业知识缺乏客观性目前正在法庭上进行。
OBJECTIVE: The objective of the study was to evaluate the intra-and interobserver agreement among obstetric experts in court regarding the retrospective review of abnormal fetal heart rate tracings and obstetrical management of patients with abnormal fetal heart rate during labor.STUDY DESIGN: A total of 22 French obstetric experts in court reviewed 30 cases of term deliveries of singleton pregnancies diagnosed with at least 1 hour of abnormal fetal heart rate, including 10 cases with adverse neonatal outcome. The experts reviewed all cases twice within a 3-month interval, with the first review being blinded to neonatal outcome. For each case reviewed, the experts were provided with the obstetric data and copies of the complete fetal heart rate recording and the partogram. The experts were asked to classify the abnormal fetal heart rate tracing and to express whether they agreed with the obstetrical management performed. When they disagreed, the experts were asked whether they concluded that an error had been made and whether they considered the obstetrical management as the cause of cerebral palsy in children if any.RESULTS: Compared with blinded review, the experts were significantly more likely to agree with the obstetric management performed (P < .001) and with the mode of delivery (P < .001) when informed about the neonatal outcome and were less likely to conclude that an error had been made (P < .001) or to establish a link with potential cerebral palsy (P = .003). The experts' intraobserver agreement for the review of abnormal fetal heart rate tracing and obstetrical management were both mediocre (kappa = 0.46-0.51 and kappa = 0.48-0.53, respectively). The interobserver agreement for the review of abnormal fetal heart rate tracing was low and was not improved by knowledge of the neonatal outcome (kappa = 0.11-0.18). The interobserver agreement for the interpretation of obstetrical management was also low (kappa = 0.08-0.19) but appeared to be improved by knowledge of the neonatal outcome (kappa = 0.15-0.32).CONCLUSION: The intra-and interobserver agreement among obstetric experts in court for the review of abnormal fetal heart rate tracing and the appropriateness of obstetrical care is poor, suggesting a lack of objectivity of obstetrical expertise as currently performed in court.