Document Detail


Inter-observer agreement in clinical decision-making for abnormal cardiotocogram (CTG) during labour: a comparison between CTG and CTG plus STAN.
MedLine Citation:
PMID:  19515149     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare inter-observer agreement for clinical decision-making with cardiotocography (CTG) and combined CTG with ST-segment analysis (STAN). DESIGN: Experimental study. SETTING: Three hospital obstetrics departments in France. POPULATION: Thirty randomly selected nonreassuring CTG recordings during labour of women with singleton term pregnancies in cephalic position. METHODS: Seven obstetricians independently assessed the tracings, displayed in a random order on their computers, on two separate sessions, the first without and the second with STAN information. The observers received clinical information about the labour as the tracings continued and were asked whether they would intervene. For analysis, we considered that intervention was justified for the neonates with pH < 7.05 and that nonintervention was justified for those with a pH > 7.10 after spontaneous delivery. MAIN OUTCOME MEASURES: Kappa values and rates of inter-observer agreement for intervention and for nonintervention. RESULTS: Kappa for inter-observer agreement was 0.50 (0.29-0.69) with CTG, and 0.67 (0.48-0.81) with CTG + STAN. The rate of inter-observer agreement for the decision to intervene was 73% (68-77%) with CTG and 70% (66-75%) with CTG + STAN (P = 0.4), and for the nonintervention decision it was 48% (42-54%) and 69% (64-74%), respectively (P < 0.0001). The rate of agreement for justified intervention was 94% (91-97%) with CTG and 85% (80-90%) with CTG + STAN (P < 0.001) and for justified nonintervention, 56% (48-63%) with CTG and 84% (79-89%) with CTG + STAN (P < 0.0001). CONCLUSIONS: In cases with abnormal CTG, ST analysis may improve consistency in clinical decision-making and decrease unnecessary interventions, but may also lead on rare occasions to unjustified decisions not to intervene.
Authors:
C Vayssière; V Tsatsaris; O Pirrello; C Cristini; C Arnaud; F Goffinet
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  116     ISSN:  1471-0528     ISO Abbreviation:  BJOG     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-06-11     Completed Date:  2009-08-11     Revised Date:  2009-12-17    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  1081-7; discussion 1087-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynaecology, CMCO-SIHCUS, Louis Pasteur University, Strasbourg, France. cvayssiere@club-internet.fr
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MeSH Terms
Descriptor/Qualifier:
Acidosis / diagnosis,  physiopathology
Arrhythmias, Cardiac / diagnosis*,  physiopathology
Cardiotocography / methods,  standards*
Clinical Competence / standards*
Electrocardiography / standards*
Female
Fetal Diseases / diagnosis*,  physiopathology
Fetal Distress / diagnosis*,  physiopathology
Heart Rate, Fetal / physiology
Humans
Observer Variation
Sensitivity and Specificity
Comments/Corrections
Comment In:
BJOG. 2010 Jan;117(1):121; author reply 121-2   [PMID:  20002383 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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