Dougherty Anne, Kasten Miriam, DeSarno Michael, Badger Gary, Streeter Mary, Jones David C, Sussman Betsy, DeStigter Kristen
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
University of Vermont, Burlington, Vermont, USA.
J Ultrasound Med. 2021 Mar;40(3):529-540. doi: 10.1002/jum.15429. Epub 2020 Aug 8.
A remote quality assurance and improvement protocol for point-of-care obstetric ultrasound in low-resource areas was validated against the standard of care for obstetric ultrasound in the United States.
Compressed movie clip ultrasound images (obstetric sweep protocol) obtained by minimally trained personnel were read and interpreted by physicians with training in obstetric ultrasound. Observed findings were compared among readers and between each reader and the gold standard ultrasound scan report. Descriptive statistics were used for the analysis.
The agreements among readers and between readers and the gold standard, for the anterior and posterior variables of the placental location were excellent, with Cohen κ values of 0.81 to 0.88 and 0.77 to 0.9, respectively. Cohen κ values were slight or slight/fair for other placental locations (left, right, fundal, and low), and the sensitivity and specificity ranged widely. The agreement among readers and between readers and the gold standard for fetal number comparisons was also excellent, with Cohen κ values ranging from 0.82 to 1, sensitivity from 0.83 to 1, and specificity from 0.99 to 1. The agreement among readers for fetal presentation comparisons, according to the Cohen κ, ranged from 0.79 to 0.85 and between readers and the gold standard had values of 0.43 to 0.49. For biometric parameters and estimated gestational age calculations based on these parameters, inter-reader reliability ranged from 0.79 to 0.85 for all parameters except femur length. Greater than 94% of obstetric sweep protocol ultrasound ages were within 7 days of the corresponding gold standard age.
Movie clip ultrasound images provided adequate information for remote readers to reliably determine the placental location, fetal number, fetal presentation, and pregnancy dating.
针对资源匮乏地区的即时产科超声检查，一项远程质量保证与改进方案已依据美国产科超声检查的护理标准进行了验证。
由经过最少培训的人员获取的压缩电影片段超声图像（产科扫查方案），由接受过产科超声检查培训的医生进行读取和解读。对不同读者之间以及每位读者与金标准超声扫描报告之间观察到的结果进行比较。采用描述性统计进行分析。
对于胎盘位置的前后变量，读者之间以及读者与金标准之间的一致性极佳，Cohen κ值分别为0.81至0.88和0.77至0.9。对于其他胎盘位置（左侧、右侧、宫底和低位），Cohen κ值为轻微或轻微/一般，敏感性和特异性范围广泛。在胎儿数量比较方面，读者之间以及读者与金标准之间的一致性也极佳，Cohen κ值范围为0.82至1，敏感性为0.83至1，特异性为0.99至1。根据Cohen κ值，读者之间在胎儿先露比较方面的一致性范围为0.79至0.85，读者与金标准之间的值为0.43至0.49。对于生物测量参数以及基于这些参数的估计孕周计算，除股骨长度外，所有参数的读者间可靠性范围为0.79至0.85。超过94%的产科扫查方案超声孕周与相应的金标准孕周相差在7天之内。
电影片段超声图像为远程读者可靠地确定胎盘位置、胎儿数量、胎儿先露和孕周提供了足够的信息。
