Myer Emily N B, Too Gloria T, Hammad Ibrahim A, Babbar Shilpa, Martin Charley E, Hill James B, Blackwell Sean B, Chauhan Suneet P
Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.
Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Am J Perinatol. 2015 Apr;32(5):427-44. doi: 10.1055/s-0034-1396684. Epub 2014 Dec 29.
To compare the obstetric recommendations in American Congress of Obstetricians and Gynecologists (ACOG) practice bulletins (PB) with similar topics in UpToDate (UTD).
We accessed all obstetric PB and cross-searched UTD (May 1999-May 2013). We analyzed only the PB which had corresponding UTD chapter with graded recommendations (level A-C). To assess comparability of recommendations for each obstetric topic, two maternal-fetal medicine (MFM) subspecialists categorized the statement as similar, dissimilar, or incomparable. Simple and weighted kappa statistics were calculated to assess agreement between the two raters.
We identified 46 ACOG obstetric PB and 86 UTD chapters. There were 50% fewer recommendations in UTD than in PB (181 vs. 365). The recommendations being categorized as level A, B, or C was significantly different (p < 0.001) for the two guidelines. While the overall concordance rate between the two MFM subspecialists was 83% regarding the recommendations for the same topic as similar, dissimilar, or incomparable, the agreement was moderate (kappa, 0.56; 95% confidence intervals, 0.48-0.65).
Though obstetricians have two sources for graded recommendations, incongruity among them may be a source of consternation. Congruent recommendations from ACOG and UTD could enhance compliance and potentially optimize outcomes.
比较美国妇产科医师学会（ACOG）实践公告（PB）中的产科建议与UpToDate（UTD）中类似主题的建议。
我们查阅了所有产科PB，并对UTD进行交叉检索（1999年5月至2013年5月）。我们仅分析了与具有分级建议（A - C级）的UTD章节相对应的PB。为评估每个产科主题建议的可比性，两名母胎医学（MFM）亚专科医生将陈述分类为相似、不相似或不可比。计算简单和加权kappa统计量以评估两名评估者之间的一致性。
我们确定了46篇ACOG产科PB和86个UTD章节。UTD中的建议比PB少50%（181条对365条）。两条指南中被分类为A、B或C级的建议存在显著差异（p < 0.001）。虽然两名MFM亚专科医生对于同一主题的建议在相似、不相似或不可比方面的总体一致率为83%，但一致性为中等（kappa值为0.56；95%置信区间为0.48 - 0.65）。
尽管产科医生有两个获取分级建议的来源，但它们之间的不一致可能是困惑的一个来源。ACOG和UTD的一致建议可以提高依从性并可能优化结果。
