Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines
Agreement and accuracy using the FIGO, ACOG and NICE cardiotocography interpretation guidelines
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DOI：
10.1111/aogs.13064
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发表时间：
2017-02-01
影响因子：
4.3
通讯作者：
Da Graca, Luis M.
中科院分区：
文献类型：
--
作者：
Santo, Susana;Ayres-de-Campos, Diogo;Da Graca, Luis M.
介绍心宫监护报告的局限性之一是在追踪解释中观察到的观察者间一致性不高。本研究比较了国际妇产科联合会、美国妇产科学会和国家健康与护理卓越研究所指南的胎心宫缩描记解读的一致性、可靠性和准确性。材料和方法来自三个中心的 27 名临床医生对总共 151 项描记进行了评估，这些中心常规使用国际妇产科联合会、美国妇产科学会和国家健康与护理卓越研究所指南。使用统计数据的一致性和可靠性比例来评估观察者间的一致性。评估了病理/III 类描记的准确性，以预测新生儿酸血症。对于所有测量，计算了 95% 置信区间。 结果心宫图分类更多地分布在国际妇产科联合会 (9, 52, 39%) 和国家健康与护理卓越研究所 (30, 33, 37%) 中，而不是美国妇产科学会 (13, 81, 6%) 中。一致性最高的类别是美国妇产科协会 II 类（一致性比例 = 0.73，95% 置信区间 0.70-76），一致性最低的是美国妇产科协会 I 类和 III 类。国际妇产科联合会 (= 0.37，95% 置信区间 0.31-0.43) 和国家健康与护理卓越研究所 (= 0.33，95% 置信区间 0.28-0.39) 的可靠性显着高于美国妇产科学院 (= 0.15，95% 置信区间) 0.10-0.21）；然而，所有这些都仅代表轻微/一般的可靠性。国际妇产科联合会和美国国家健康与护理卓越研究所显示，预测新生儿酸血症的敏感性（分别为 89% 和 97%）高于美国妇产科学院（32%），但后者的特异性显着更高（95%）。结论与美国妇产科学院指南的 II 类指南高度一致，预测可靠性低、敏感性低、特异性高酸血症。国际妇产科联合会和国家健康与护理卓越研究所的指南在酸血症预测方面具有更高的可靠性、更高的敏感性和更低的特异性。
IntroductionOne of the limitations reported with cardiotocography is the modest interobserver agreement observed in tracing interpretation. This study compared agreement, reliability and accuracy of cardiotocography interpretation using the International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines.Material and methodsA total of 151 tracings were evaluated by 27 clinicians from three centers where International Federation of Gynecology and Obstetrics, American College of Obstetrics and Gynecology and National Institute for Health and Care Excellence guidelines were routinely used. Interobserver agreement was evaluated using the proportions of agreement and reliability with the statistic. The accuracy of tracings classified as pathological/category III was assessed for prediction of newborn acidemia. For all measures, 95% confidence interval were calculated.ResultsCardiotocography classifications were more distributed with International Federation of Gynecology and Obstetrics (9, 52, 39%) and National Institute for Health and Care Excellence (30, 33, 37%) than with American College of Obstetrics and Gynecology (13, 81, 6%). The category with the highest agreement was American College of Obstetrics and Gynecology category II (proportions of agreement = 0.73, 95% confidence interval 0.70-76), and the ones with the lowest agreement were American College of Obstetrics and Gynecology categories I and III. Reliability was significantly higher with International Federation of Gynecology and Obstetrics ( = 0.37, 95% confidence interval 0.31-0.43), and National Institute for Health and Care Excellence ( = 0.33, 95% confidence interval 0.28-0.39) than with American College of Obstetrics and Gynecology ( = 0.15, 95% confidence interval 0.10-0.21); however, all represent only slight/fair reliability. International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence showed a trend towards higher sensitivities in prediction of newborn acidemia (89 and 97%, respectively) than American College of Obstetrics and Gynecology (32%), but the latter achieved a significantly higher specificity (95%).ConclusionsWith American College of Obstetrics and Gynecology guidelines there is high agreement in category II, low reliability, low sensitivity and high specificity in prediction of acidemia. With International Federation of Gynecology and Obstetrics and National Institute for Health and Care Excellence guidelines there is higher reliability, a trend towards higher sensitivity, and lower specificity in prediction of acidemia.