Agreement on intrapartum cardiotocogram recordings between expert obstetricians
Agreement on intrapartum cardiotocogram recordings between expert obstetricians
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DOI：
10.1111/jep.12368
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发表时间：
2015-08-01
影响因子：
2.4
通讯作者：
Lhotska, Lenka
中科院分区：
文献类型：
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作者：
Hruban, Lukas;Spilka, Jiri;Lhotska, Lenka
Rationality，aims and objectivesTo evaluate obstitutes 'inter-and intra-observer agreement on intrapartition cardiotocogram（CTG）recordings and to examine obstitutes' evaluations with respect to umbilical artery pH and base deficits.MethodsNine experienced obstitutes annotated 634 intrapartition CTG recordings.每个记录的评价分为四个步骤：在第一产程中评价两个30分钟的窗口，在第二产程中评价一个窗口和产程结局预测。用于本实验的完整评估集可在线获得。使用一致性比例和kappa系数评价观察者间和观察者内一致性。临床医生的敏感性和特异性计算相对于脐动脉pH值，碱赤字和Apgar评分在第五minut.ResultsThe临床医生之间的协议的总体比例达到48%，95%的置信区间（CI）（CI：47-50）。对于不同的分类，一致率范围为正常的57%（CI：54-60）至病理分类的41%（CI：36-46）。临床医生的多数票客观结局的敏感性为39%（CI：16-63）的脐动脉基础赤字和27%（CI：16-42）的pH值。特异性为89%（CI：86-92）为两种类型的客观outcome.ConclusionsThe报告间/观察者内的变异性是大的，这与临床医生的经验或工作场所无关。结果支持需要现代化的指导方针，CTG评价和/或客观化和可重复性，通过引入一种计算机化的方法，可以标准化的过程中，CTG的评价交付病房。
Rationale, aims and objectivesTo evaluate obstetricians' inter- and intra-observer agreement on intrapartum cardiotocogram (CTG) recordings and to examine obstetricians' evaluations with respect to umbilical artery pH and base deficit.MethodsNine experienced obstetricians annotated 634 intrapartum CTG recordings. The evaluation of each recording was divided into four steps: evaluation of two 30-minute windows in the first stage of labour, evaluation of one window in the second stage of labour and labour outcome prediction. The complete set of evaluations used for this experiment is available online. The inter- and intra-observer agreement was evaluated using proportion of agreement and kappa coefficient. Clinicians' sensitivity and specificity was computed with respect to umbilical artery pH, base deficit and to Apgar score at the fifth minute.ResultsThe overall proportion of agreement between clinicians reached 48% with 95% confidence intervals (CI) (CI: 47-50). Regarding the different classes, proportion of agreement ranged from 57% (CI: 54-60) for normal to 41% (CI: 36-46) for pathological class. The sensitivity of clinicians' majority vote to objective outcome was 39% (CI: 16-63) for the umbilical artery base deficit and 27% (CI: 16-42) for pH. The specificity was 89% (CI: 86-92) for both types of objective outcome.ConclusionsThe reported inter-/intra-observer variability is large and this holds irrespective of clinicians' experience or work place. The results support the need of modernized guidelines for CTG evaluation and/or objectivization and repeatability by introduction of a computerized approach that could standardize the process of CTG evaluation within the delivery ward.