Figueras Francesc, Albela Sonia, Bonino Silvana, Palacio Montse, Barrau Enrique, Hernandez Sandra, Casellas Carme, Coll Oriol, Cararach Vicenç
Department of Obstetrics, Hospital Clinic, Barcelona, Spain.
J Perinat Med. 2005;33(3):241-5. doi: 10.1515/JPM.2005.044.
To evaluate the inter- and intra-observer agreement of visual analysis of fetal heart rate tracing and to evaluate the bias introduced by knowledge of perinatal outcome in this interpretation.
One hundred tracings were independently analyzed by four observers. In a second study period, two observers re-analysed the 100 tracings in order to evaluate intra-observer agreement. The other two observers re-analyzed the tracings, which were labelled with fictitious perinatal outcome to evaluate the impact of this information on reliability. Agreement was analyzed by means of the proportion of agreement for qualitative parameters and the inter- and intra-class correlation coefficient for quantitative data.
Poor agreement was found for quantitative variability, low variability category and number of decelerations. Moderate agreement was observed for baseline, normal variability category and number of accelerations. Fetal heart rate variability and number of accelerations and decelerations were found to be significantly influenced by clinical information of perinatal outcome. Biased observers showed lower reliability than unbiased ones.
Visual assessment of fetal heart rate tracings is unreliable due to low rates of agreement between and within observers. Only qualitative classification such as normal baseline and normal variability showed good agreement. Knowledge of clinical information introduces subjectivity to the visual analysis, leading to a negative impact on reliability.
评估胎儿心率描记图视觉分析中观察者间和观察者内的一致性，并评估围产期结局信息在这种解读中所引入的偏差。
四位观察者对100份描记图进行独立分析。在第二个研究阶段，两位观察者对这100份描记图进行重新分析，以评估观察者内的一致性。另外两位观察者对标记有虚构围产期结局的描记图进行重新分析，以评估此信息对可靠性的影响。通过定性参数的一致性比例以及定量数据的组间和组内相关系数来分析一致性。
在定量变异性、低变异性类别和减速次数方面发现一致性较差。在基线、正常变异性类别和加速次数方面观察到中等一致性。发现胎儿心率变异性以及加速和减速次数受到围产期结局临床信息的显著影响。有偏差的观察者显示出比无偏差的观察者更低的可靠性。
由于观察者间和观察者内的一致性率较低，胎儿心率描记图的视觉评估不可靠。只有诸如正常基线和正常变异性等定性分类显示出良好的一致性。临床信息的知晓给视觉分析带来主观性，对可靠性产生负面影响。
