Measurement error for ultrasound fetal biometry performed by paramedics in rural Bangladesh
Measurement error for ultrasound fetal biometry performed by paramedics in rural Bangladesh
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DOI：
10.1002/uog.6385
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发表时间：
2009-10-01
影响因子：
7.1
通讯作者：
Frongillo, E. A.
中科院分区：
文献类型：
--
作者：
Neufeld, L. M.;Wagatsuma, Y.;Frongillo, E. A.
Objectives To document the accuracy and precision of ultrasonic fetal biometric performed by nine paradics from rural Bangladesh.Methods paradics undertaken intensive training（6 weeks）including hands-on-practice then undertaken a series of standardization exercises.由一名训练有素的医生（研究主管）和9名护理人员对每只胎仔进行测量。每名护理人员和医生使用标准程序对每名胎仔测量两次妊娠10周以下胎仔的顶臀长（CRL）、双顶径（BPD）、枕额径、头围和腹围（AC）以及股骨干长度（FL），两次测量之间至少间隔20 min。使用方差分量分析量化精度;通过比较对同一参与者进行的重复测量来计算每个护理人员的观察者内误差，并且还将每个护理人员获得的测量值与其他护理人员获得的测量值进行比较（观察者间误差）。使用配对t检验，通过比较每名护理人员与研究主管采取的两项措施的平均值来估计准确度。Bland-Altman图用于直观评估重复测量的精确度（观察者内误差）与胎儿大小之间的关系。结果共有180名妊娠7至31周的女性参与了该研究。由护理人员获得的测量值的观察者内误差（表示为平均SD）范围从孕早期的BPD的0.97 mm到孕晚期的AC的7.25 mm，并且对于大多数测量值来说大于观察者间误差（即占总方差的更大比例）。观察者之间的误差范围为0.00毫米的FL到3.36毫米的A C，都在孕晚期。除CRL外，所有测量值的观察者内误差均随胎儿大小的增加而增加。由护理人员获得的测量结果显示出一些统计学上的显着差异，从那些获得的研究supervisor.Conclusions，但这些都是相对较小的幅度。经过严格的训练，没有接触过超声波的护理人员可以提供准确和精确的胎儿生物测量。Copyright（C）2009 ISUOG.出版社：John Wiley & Sons，Ltd
Objectives To document the accuracy and precision of sonographic fetal biometry performed by nine paramedics from rural Bangladesh.Methods Paramedics underwent intensive training (6 weeks) including hands-on practice then underwent a series of standardization exercises. Measurements of each fetus were taken by a highly-trained medical doctor (study supervisor) and the nine paramedics. Crown-rump length (CRL) in fetuses of less than 10 weeks' gestation, and biparietal diameter (BPD), occipitofrontal diameter, head and abdominal circumference (AC) and femur diaphysis length (FL) were measured twice using standard procedures by each paramedic and the medical doctor for each fetus, with at least 20 min between them. Precision was quantified using variance components analysis; the intraobserver error for each of the paramedics was calculated by comparing repeat measurements taken on the same participant, and the measurements obtained by each individual paramedic were also compared with those taken by the others (interobserver error). Accuracy was estimated by comparing the mean of the two measures taken by each paramedic to those taken by the study supervisor using paired t-tests. Bland-Altman plots were used to visually assess the relationship between precision of repeat measurements (intraobserver error) and fetal size.Results A total of 180 women, at 7 to 31 weeks' gestation, participated in the study. Intraobserver error of the measurements obtained by the paramedics, expressed as the mean SD, ranged from 0.97 mm for BPD in the first trimester to 7.25 mm for AC in the third trimester, and was larger than the interobserver error (i.e. accounting for a greater proportion of total variance) for most measurements. Interobserver error ranged from 0.00 mm for FL to 3.36 mm for A C, both in the third trimester. For all measurements except CRL, intraobserver error increased with increasing fetal size. The measurements obtained by the paramedics did show some statistically significant differences from those obtained by the study supervisor, but these were relatively small in magnitude.Conclusions Both inter- and intraobserver measurement errors were within the range reported in the literature for studies conducted by technical staff and medical doctors. With intense training,, paramedics with no prior exposure to ultrasonograpby can provide accurate and precise measures of fetal biometry. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.