Flood Margaret, Pollock Wendy, McDonald Susan J, Davey Mary-Ann
Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
Maternal Critical Care, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2018 Apr;58(2):210-216. doi: 10.1111/ajo.12692. Epub 2017 Aug 31.
The postpartum haemorrhage (PPH) rate in Victoria in 2009 for women having their first birth, based on information reported to the Victorian Perinatal Data Collection (VPDC), was 23.6% (primiparas). Prior to 2009 PPH was collected via a tick box item on the perinatal form. Estimated blood loss (EBL) volume is now collected and it is from this item the PPH rate is calculated. Periodic assessment of data accuracy is essential to inform clinicians and others who rely on these data of their quality and limitations.
This paper describes the results of a state-wide validation study of the accuracy of EBL volume and EBL-related data items reported to VPDC.
PPH data from a random sample of 1% of births in Victoria in 2011 were extracted from source medical records and compared with information submitted to the VPDC. Accuracy was determined, together with sensitivity, specificity, positive predictive value and negative predictive value for dichotomous items.
Accuracy of reporting for EBL ≥ 500 mL was 97.2% and for EBL ≥ 1500 mL was 99.7%. Sensitivity for EBL ≥ 500 mL was 89.0% (CI 83.1-93.0) and for EBL ≥ 1500 mL was 71.4% (CI 35.9-91.8). Blood product transfusion, peripartum hysterectomy and procedures to control bleeding were all accurately reported in >99% of cases.
Most PPH-related data items in the 2011 VPDC may be considered reliable. Our results suggest EBL ≥ 1500 mL is likely to be under-reported. Changes to policies and practices of recording blood loss could further increase accuracy of reporting.
根据向维多利亚围产期数据收集系统（VPDC）报告的信息，2009年维多利亚州初产妇的产后出血（PPH）率为23.6%（初产妇）。2009年之前，PPH是通过围产期表格上的一个勾选框项目收集的。现在收集估计失血量（EBL），PPH率就是根据这个项目计算出来的。定期评估数据准确性对于告知临床医生和其他依赖这些数据的人其质量和局限性至关重要。
本文描述了一项全州范围内对报告给VPDC的EBL量和与EBL相关的数据项目准确性的验证研究结果。
从2011年维多利亚州1%的随机抽样出生记录的原始医疗记录中提取PPH数据，并与提交给VPDC的信息进行比较。确定二分项目的准确性以及敏感性、特异性、阳性预测值和阴性预测值。
EBL≥500mL报告的准确性为97.2%，EBL≥1500mL报告的准确性为99.7%。EBL≥500mL的敏感性为89.0%（可信区间83.1 - 93.0），EBL≥1500mL的敏感性为71.4%（可信区间35.9 - 91.8）。血液制品输注、围产期子宫切除术和控制出血的操作在超过99%的病例中都得到了准确报告。
2011年VPDC中大多数与PPH相关的数据项目可能被认为是可靠的。我们的结果表明EBL≥1500mL可能报告不足。改变记录失血量的政策和做法可能会进一步提高报告的准确性。
