运用德尔菲法在中国实现早产单胎防治的共识。
Using the Delphi Technique to Achieve Consensus on Prevention and Treatment of Preterm Single Birth in China.
作者信息
Li Taishun, Liu Zhe, Yang Huixia, Hu Yali
机构信息
Medical Statistics and Analysis Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
出版信息
Matern Fetal Med. 2023 Oct 20;5(4):206-212. doi: 10.1097/FM9.0000000000000201. eCollection 2023 Oct.
OBJECTIVE
This study aimed to reach a consensus among obstetric experts on the prevention and treatment of preterm single births in China.
METHODS
Based on the scoping literature review and the 2014 edition of preterm birth of Clinical Diagnosis and Treatment guidelines, we generated the Delphi survey statements with five evaluation dimensions, including the definition of preterm birth, exclusion of risk factors for preterm birth, prevention, and prediction of preterm birth, treatment of preterm birth, and evaluation of intervention outcomes of preterm birth. Obstetric experts from the Obstetrics and Gynecology Branch of the Chinese Medical Association formed the expert group for this survey. All the obstetric experts participated two-round modified Delphi survey via an anonymous online survey and an online panel. Mean scores, rank sum, full score ratio, and the lowest score ratio were calculated to reflect the concentration of expert opinions. The coefficient of variation and Kendall coefficient were used to reflect the expert opinion coordination degree of the survey statement.
RESULTS
The expert response rate for both rounds of surveys was 100% (41/41). Experts reached an agreement on 36 statements in five dimensions of preterm birth prevention and treatment in the first round of the survey and reached a consensus on the remaining 13 statements in the second round. A total of 49 statements (mean scores ≥3, full score ratio ≥20%, coefficient of variation ≤0.3) were explicitly included in this guideline to form recommendations, while the remaining three clinical issues that did not reach a consensus require further determination based on evidence quality. The Kendall coefficient in the two rounds of the Delphi survey were 0.20 ( < 0.001) and 0.29 ( < 0.001).
CONCLUSION
The five dimensions and 49 statements, agreed upon through a two-round Delphi study, determined the recommended statements to be included in the updated guidelines for the prevention and treatment of preterm birth in China. The defined lower limit is set at ≥28 gestational weeks; however, an update has been made to the definition of premature birth, specifying that "with the consent of the mother and her family, treatment is not abandoned for viable infants ≥26 gestational weeks."
目的
本研究旨在就中国单胎早产的防治问题达成产科专家共识。
方法
基于文献综述和《临床诊疗指南·早产的防治》2014版，我们制定了包含五个评估维度的德尔菲调查问卷，包括早产的定义、早产危险因素的排除、早产的预防与预测、早产的治疗以及早产干预效果的评估。中华医学会妇产科学分会的产科专家组成了本次调查的专家组。所有产科专家通过匿名在线调查和在线小组讨论参与了两轮改良德尔菲调查。计算平均分、秩和、满分率和最低分率以反映专家意见的集中程度。变异系数和肯德尔系数用于反映调查问卷条目的专家意见协调程度。
结果
两轮调查的专家回复率均为100%（41/41）。专家们在第一轮调查中就早产防治的五个维度中的36条陈述达成了一致，在第二轮调查中就其余13条陈述达成了共识。本指南明确纳入了49条陈述（平均分≥3分，满分率≥20%，变异系数≤0.3）以形成推荐意见，而其余三个未达成共识的临床问题需要根据证据质量进一步确定。两轮德尔菲调查中的肯德尔系数分别为0.20（P<0.001）和0.29（P<0.001）。
结论
通过两轮德尔菲研究达成共识的五个维度和49条陈述，确定了中国早产防治更新指南中应纳入的推荐陈述。定义的下限设定为≥28孕周；然而，对早产的定义进行了更新，明确指出“在母亲及其家属同意的情况下，对于孕周≥26周的存活婴儿不放弃治疗”。
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