Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California-San Francisco, San Francisco, CA, USA.
Am J Obstet Gynecol. 2010 Nov;203(5):451.e1-7. doi: 10.1016/j.ajog.2010.05.037. Epub 2010 Jul 15.
The purpose of this study was to measure agreement among 5 expert clinicians and a computerized method with the use of a strict fetal heart rate classification method.
Five providers independently scored 769 8-minute segments from the last 3 hours of 30 tracings with the use of a 5-tier color-coded framework that contains pattern descriptions and proposals for management. Computer analysis was performed with PeriCALM Patterns (PeriGen, Princeton, NJ) to detect and classify patterns.
The clinicians agreed exactly with the majority opinion in 57% (95% confidence interval [CI], 49-64%) of the segments and were within 1 color code in 89% (95% CI, 81-96%). The average proportion of agreement was 0.83 (95% CI, 0.73-0.94). Weighted Kappa scores averaged 0.58 (range, 0.48-0.68). The computer-based results were not statistically different: 0.87 and 0.52, respectively.
These 5 clinicians achieved moderate-to-substantial levels of agreement overall using a strictly defined method to classify fetal heart rate tracings. The result of the computerized method was similar to the conclusions of these clinicians.
本研究旨在使用严格的胎儿心率分类方法，衡量 5 位专家临床医生和计算机方法之间的一致性。
5 位提供者使用包含模式描述和管理建议的 5 级彩色编码框架，对 30 条记录的最后 3 小时内的 769 个 8 分钟段进行独立评分。使用 PeriCALM Patterns（PeriGen，新泽西州普林斯顿）进行计算机分析，以检测和分类模式。
临床医生在 57%（95%置信区间 [CI]，49-64%）的分段中与多数意见完全一致，并且在 89%（95% CI，81-96%）的分段中与 1 个颜色代码一致。平均一致性比例为 0.83（95% CI，0.73-0.94）。加权 Kappa 评分平均为 0.58（范围，0.48-0.68）。基于计算机的结果在统计学上没有差异：分别为 0.87 和 0.52。
这些 5 位临床医生使用严格定义的方法对胎儿心率记录进行分类，总体上达到了中等至较大程度的一致性。计算机方法的结果与这些临床医生的结论相似。
