Centre for International Health, Curtin Health Innovation Research Institute, Curtin University of Technology, GPO Box U1987, Perth, Western Australia 6845, Australia.
Popul Health Metr. 2010 Aug 17;8:23. doi: 10.1186/1478-7954-8-23.
This study assessed the agreement between medical physicians in their interpretation of verbal autopsy (VA) interview data for identifying causes of neonatal deaths in rural Bangladesh.
The study was carried out in Matlab, a rural sub-district in eastern Bangladesh. Trained persons conducted the VA interview with the mother or another family member at the home of the deceased. Three physicians and a medical assistant independently reviewed the VA interviews to assign causes of death using the International Classification of Diseases - Tenth Revision (ICD-10) codes. A physician assigned cause was decided when at least two physicians agreed on a cause of death. Cause-specific mortality fraction (CSMF), kappa (k) statistic, sensitivity, specificity, and positive predictive values were applied to compare agreement between the reviewers.
Of the 365 neonatal deaths reviewed, agreement on a direct cause of death was reached by at least two physicians in 339 (93%) of cases. Physician and medical assistant reviews of causes of death demonstrated the following levels of diagnostic agreement for the main causes of deaths: for birth asphyxia the sensitivity was 84%, specificity 93%, and kappa 0.77. For prematurity/low birth weight, the sensitivity, specificity, and kappa statistics were, respectively, 53%, 96%, and 0.55, for sepsis/meningitis they were 48%, 98%, and 0.53, and for pneumonia they were 75%, 94%, and 0.51.
This study revealed a moderate to strong agreement between physician- assigned and medical assistant- assigned major causes of neonatal death. A well-trained medical assistant could be considered an alternative for assigning major causes of neonatal deaths in rural Bangladesh and in similar settings where physicians are scarce and their time costs more. A validation study with medically confirmed diagnosis will improve the performance of VA for assigning cause of neonatal death.
本研究评估了医疗医师在解释口头尸检（VA）访谈数据以确定孟加拉国农村新生儿死亡原因方面的一致性。
该研究在孟加拉国东部的农村分区 Matlab 进行。经过培训的人员在死者家中对母亲或其他家庭成员进行 VA 访谈。三名医生和一名医疗助理独立审查 VA 访谈，使用国际疾病分类第十版（ICD-10）代码分配死因。当至少两名医生就死因达成一致时，就确定了医生指定的死因。应用病死率特定部分（CSMF）、kappa（k）统计量、敏感性、特异性和阳性预测值来比较审阅者之间的一致性。
在审查的 365 例新生儿死亡中，至少有两名医生就直接死因达成一致的病例有 339 例（93%）。医生和医疗助理对死因的审查显示，主要死因的诊断一致性水平如下：对于出生窒息，敏感性为 84%，特异性为 93%，kappa 值为 0.77。对于早产/低出生体重，敏感性、特异性和 kappa 统计量分别为 53%、96%和 0.55，对于败血症/脑膜炎为 48%、98%和 0.53，对于肺炎为 75%、94%和 0.51。
本研究表明，医生和医疗助理分配的主要新生儿死亡原因之间存在中度到高度一致。在医生稀缺且时间成本更高的孟加拉国农村和类似环境中，可以考虑培训有素的医疗助理来替代分配主要新生儿死亡原因。与医学确诊诊断的验证研究将提高 VA 分配新生儿死亡原因的性能。
