Objective

To study whether a revision of CTG guidelines and educational program influenced the perceived need for intervention by residents in obstetrics and gynecology. A secondary aim was to study the sensitivity and specificity of the classification pathological after classification by residents using two different guidelines in identifying neonates with acidemia.

Study design:

Cardiotocograms, CTGs, from 223 neonates with acidemia at birth (cord blood pH < 7.05 at vaginal birth or second stage cesarean, or pH < 7.10 at first stage cesarean) were included, as well as 223 CTGs from neonates with cord blood pH ≥ 7.15.

Two separate groups of residents, who each were educated in and had clinical experience only from either of the two different guidelines, SWE09 and SWE17, classified the patterns according to the at the time current template and judged whether the patterns indicated an intervention. Sensitivity, specificity, and agreement were calculated.

Results

Residents using SWE09 found indication to intervene in a higher proportion of neonates with acidemia (84.8%) than residents using SWE17 (75.8%; p = 0.002), as well as in cases without acidemia (29.6% vs 22.4%; p = 0.038).

Among residents using SWE09 the perceived need for intervention had a sensitivity of 85% and a specificity of 70% to identify acidemia. With SWE17 the corresponding rates were 76% and 78%.

The sensitivity to identify neonates with acidemia by classification pathological was 91% with SWE09 and 72% with SWE17. The specificity was 53% and 76% respectively.

The agreement rate between perception of indication to intervene and classification pathological using the SWE09 was κ 0.73, moderate, and with the SWE17 κ 0.77, moderate.

The agreement on subjective perception of necessity to intervene between users of the two templates was weak to moderate, κ 0.60, and on classification pathological weak, κ 0.47.

Conclusion

The perceived need for intervention by residents interpreting CTGs was significantly affected by the guidelines in use. The difference in decisions were less pronounced than the difference in classification.

The sensitivity for both perceived need for intervention and for classification pathological to identify acidosis was higher with SWE09, and the specificity higher with SWE17, when assessed by the two comparable groups of residents.

中文翻译：

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CTG解释模板影响居民决策

客观的

研究 CTG 指南和教育计划的修订是否影响住院医师对妇产科干预的感知需求。次要目的是研究居民使用两种不同的指南对酸血症新生儿进行分类后病理学分类的敏感性和特异性。

学习规划：

包括 223 名出生时患有酸血症的新生儿（阴道分娩或二期剖宫产时脐带血 pH < 7.05，或一期剖宫产时 pH < 7.10）的心电图和 CTG，以及 223 名脐带血 pH ≥ 7.15 的新生儿的 CTG .

两个独立的居民组，每个人都接受过两种不同指南 SWE09 和 SWE17 中任何一种的教育并具有临床经验，他们根据当时的模板对模式进行分类，并判断模式是否表明干预。计算灵敏度、特异性和一致性。

结果

使用 SWE09 的居民发现，与使用 SWE17 的居民（75.8%；p = 0.002）以及没有酸血症的病例（29.6% 对 22.4%；p = 0.038）相比，使用 SWE09 的居民发现有指征干预更高比例的酸血症新生儿 (84.8%) .

在使用 SWE09 的居民中，感知到的干预需求对识别酸血症的敏感性为 85%，特异性为 70%。对于 SWE17，相应的比率为 76% 和 78%。

通过病理分类识别酸血症新生儿的敏感性在 SWE09 中为 91%，在 SWE17 中为 72%。特异性分别为 53% 和 76%。

使用 SWE09 对干预指征的感知与病理分类之间的一致性率为 κ 0.73，中等，而 SWE17 κ 0.77，中等。

两个模板的用户之间关于干预必要性的主观认知的一致性为弱到中等，κ 0.60，病理分类弱，κ 0.47。

结论

居民对解释 CTG 的干预的感知需求受到所用指南的显着影响。决策上的差异不如分类上的差异明显。

当由两组可比较的居民进行评估时，SWE09 对感知干预需求和识别酸中毒的病理分类的敏感性更高，而 SWE17 的特异性更高。