Inconsistencies in clinical decisions in obstetrics.
Analysis of the increasing incidence of caesarean section in an English teaching hospital over a 15-year period revealed that emergency caesarean section for the diagnosis of fetal distress in labour made a major contribution to this increasing trend. A retrospective audit of a sample of these operations by the consultants of the hospital indicated that 30% of the operations were unnecessary. There were two other disturbing findings in our audit. First, there was significant disagreement between auditors in the decision whether to do a caesarean section or not. Second, and perhaps more importantly, when faced with identical information at a different time, the auditors were inconsistent in 25% of cases. The disturbing clinical situation highlighted by this study may have implications for medical jurisprudence.
Barrett
J F
JF
Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds, UK.
Jarvis
G J
GJ
Macdonald
H N
HN
Buchan
P C
PC
Tyrrell
S N
SN
Lilford
R J
RJ
D002585:Cesarean Section / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006801:Humans; D008485:Medical Audit; D015588:Observer Variation; D011247:Pregnancy; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology