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首页> 外文期刊>Journal of advanced nursing >Midwives' visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement.
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Midwives' visual interpretation of intrapartum cardiotocographs: intra- and inter-observer agreement.

机译：助产士对产时心动描记器的视觉解释：观察者内部和观察者之间的一致性。

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AIM: This paper reports an examination of intra- and inter-observer agreement in midwives' visual interpretation of intrapartum cardiotocographs (CTGs). BACKGROUND: The issue of intra- and inter-observer agreement in the interpretation of CTG interpretation has serious implications for the validity of electronic fetal heart rate monitoring and subsequent decisions on intrapartum management. However, no studies were found that assessed intra- and inter-observer agreement in midwives' interpretations of CTG tracings. METHODS: Twenty-eight midwives independently interpreted three intrapartum CTG tracings on two separate occasions using a self-administered Cardiotocograph Interpretation Skills Test. Inter-rater agreement in interpretation was assessed by cross-tabulating the two sets of raw data obtained at time 1 and time 2 and computing Cohen's Kappa (kappa). Intra-rater agreement was assessed by computing kappa for each rater with the two sets of raw data (time 1 and time 2) obtained from each individual. The data were collected in 2000. RESULTS: Overall intra-rater agreement ranged from 'fair to good' (kappa = 0.48) to 'excellent' (kappa = 0.92). Raters' classifications altered in 18% (n = 5) of cases for the normal tracing, in 29% (n = 8) for the suspicious tracing and in 11% (n = 3) for the pathological tracing. Inter-rater agreement was fair to good, with kappa statistics ranging from 0.65 to 0.74, respectively. Agreement was highest in the classification of decelerations (kappa = 0.79) and lowest in the assessment of baseline variability (kappa = 0.50). Overall inter-rater agreement was highest in the suspicious tracing (kappa = 0.77, excellent) and lowest in the normal tracing (kappa = 0.54, fair to good). CONCLUSION: Inter- and intra-observer variability are intrinsic characteristics of the interpretation of intrapartum CTGs. Levels of agreement revealed degrees of variation that expose room for improvement. Efforts are needed to reduce inter- and intra-observer variation in interpretation of intrapartum CTG tracings. In addition, research should focus on the development and evaluation of non-invasive, low observer variability methods of intrapartum assessment of fetal well-being. The subjectivity of CTG interpretation and inconsistencies in interpretation should also be considered in intrapartum management, clinical audit and in medico-legal settings.
机译：目的：本文报道了对助产士对产程内心电图（CTG）的视觉解释中观察者间和观察者间一致性的检查。背景：CTG解释的观察者内部和观察者之间的一致性问题对电子胎儿心率监测以及随后对分娩期管理的决策的有效性产生严重影响。但是，在助产士对CTG描记的解释中，没有发现评估观察者之间和观察者之间一致性的研究。方法：二十八名助产士在两次单独的情况下使用自行执行的心动描记器解释技能测试独立解释了三个分娩期CTG描记。通过交叉制表在时间1和时间2获得的两组原始数据并计算科恩氏Kappa（kappa），评估了解释者之间的一致性。通过使用从每个人获得的两组原始数据（时间1和时间2）为每个评估者计算kappa来评估评估者内部协议。数据收集于2000年。结果：总体评分者内部一致性从“一般到良好”（kappa = 0.48）到“优秀”（kappa = 0.92）。正常追踪者中有18％（n = 5）的病例有分级者，可疑追踪者中有29％（n = 8）的病例，病理学追踪者有11％（n = 3）的病例的分类者有所变化。评分者之间的协议是公平的，kappa统计值分别在0.65到0.74之间。在减速度分类中一致性最高（kappa = 0.79），在基线变异性评估中一致性最低（kappa = 0.50）。总体评分者之间的一致性在可疑跟踪中最高（kappa = 0.77，优秀），在正常跟踪中最低（kappa = 0.54，公平到良好）。结论：观察者间和观察者间的变异性是解释产时CTG的内在特征。协议水平揭示了变化的程度，暴露出改进的余地。需要努力减少观察者之间和观察者内部对产时CTG示踪解释的差异。此外，研究应集中于胎儿健康状况评估的无创，低观察者变异性方法的开发和评估。 CTG解释的主观性和解释的不一致之处也应在产时管理，临床审核和法医学环境中加以考虑。

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