González Baltasar Sánchez, Martínez Laura, Cerdà Manel, Piacentini Enrique, Trenado Josep, Quintana Salvador
Intensive Care Department, Hospital Universitari Mútua Terrassa. PhD program, University of Barcelona. Terrassa, Spain Consell Català de Ressuscitació. Barcelona, Spain Intensive Care Department, Hospital Universitari Mútua Terrassa. University of Barcelona. Terrassa, Spain.
Medicine (Baltimore). 2017 Mar;96(13):e6515. doi: 10.1097/MD.0000000000006515.
This paper aims to analyze agreement in the assessment of external chest compressions (ECC) by 3 human raters and dedicated feedback software.While 54 volunteer health workers (medical transport technicians), trained and experienced in cardiopulmonary resuscitation (CPR), performed a complete sequence of basic CPR maneuvers on a manikin incorporating feedback software (Laerdal PC v 4.2.1 Skill Reporting Software) (L), 3 expert CPR instructors (A, B, and C) visually assessed ECC, evaluating hand placement, compression depth, chest decompression, and rate. We analyzed the concordance among the raters (A, B, and C) and between the raters and L with Cohen's kappa coefficient (K), intraclass correlation coefficients (ICC), Bland-Altman plots, and survival-agreement plots.The agreement (expressed as Cohen's K and ICC) was ≥0.54 in only 3 instances and was ≤0.45 in more than half. Bland-Altman plots showed significant dispersion of the data. The survival-agreement plot showed a high degree of discordance between pairs of raters (A-L, B-L, and C-L) when the level of tolerance was set low.In visual assessment of ECC, there is a significant lack of agreement among accredited raters and significant dispersion and inconsistency in data, bringing into question the reliability and validity of this method of measurement.
本文旨在分析3名人类评估者和专用反馈软件在评估胸外按压（ECC）方面的一致性。54名经过心肺复苏（CPR）培训且经验丰富的志愿医护人员（医疗运输技术员）在配备反馈软件（Laerdal PC v 4.2.1技能报告软件）（L）的人体模型上进行了完整的基本CPR操作序列，3名CPR专家讲师（A、B和C）对ECC进行了视觉评估，评估手部位置、按压深度、胸部减压和频率。我们使用科恩kappa系数（K）、组内相关系数（ICC）、布兰德-奥特曼图和生存一致性图分析了评估者（A、B和C）之间以及评估者与L之间的一致性。一致性（以科恩K和ICC表示）仅在3种情况下≥0.54，超过一半的情况≤0.45。布兰德-奥特曼图显示数据存在显著离散。当容忍度设置较低时，生存一致性图显示评估者对（A-L、B-L和C-L）之间存在高度不一致。在ECC的视觉评估中，认可的评估者之间存在显著的一致性不足，数据存在显著离散和不一致，这使得这种测量方法的可靠性和有效性受到质疑。
