title: The role of observer error in antenatal dipstick proteinuria analysis.
abstract: OBJECTIVE
  To determine the role of inter-observer error and the influence of training upon dipstick urine analysis.
  
  
  METHODS
  A two phase observational and training study.
  
  
  METHODS
  Five standard solutions of serum albumin were used to test the accuracy of midwives and nursing auxiliaries involved in dipstick urine analysis at a maternity hospital. The standard solutions were chosen such that they should have resulted in negative (n = 2) and positive (n = 3) dipstick test results, respectively.
  
  
  METHODS
  A teaching maternity hospital and academic department of obstetrics and gynaecology.
  
  
  METHODS
  Twenty midwives, 20 nursing auxiliaries and nine laboratory technicians.
  
  
  RESULTS
  For the two nonproteinuric solutions, a higher false positive rate was observed for nursing auxiliaries (40% and 55%), compared with midwives (5% and 30%) (P = 0.020 and P = 0.20, respectively). Before training, laboratory technicians recorded high false positive rates (67% and 89%), but after training these were reduced to 0% and 22% (P = 0.25 and P = 0.023, respectively). Both nursing auxiliaries and midwives recorded false negative rates of between 10% and 45% for the three proteinuric solutions.
  
  
  CONCLUSIONS
  Observer error may be reduced by assigning midwives to urine dipstick analysis or by the implementation of directed training. Classification of pre-eclampsia or other hypertensive diseases of pregnancy on the basis of the presence and degree of proteinuria should be confirmed with a 24-hour quantitative protein collection.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Leicester, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Bell
authors.forename: A W
authors.initials: AW
authors.lastname: Halligan
authors.forename: A
authors.initials: A
authors.lastname: Martin
authors.forename: J
authors.initials: J
authors.lastname: Ashmore
authors.forename: A H
authors.initials: AH
authors.lastname: Shennan
authors.forename: P C
authors.initials: PC
authors.lastname: Lambert
authors.forename: D J
authors.initials: DJ
authors.lastname: Taylor
mesh_terms: D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006771:Hospitals, Maternity; D006784:Hospitals, Teaching; D006801:Humans; D007318:Inservice Training; D008505:Medical Staff, Hospital / Q000592:standards; D009726:Nurses / Q000592:standards; D015588:Observer Variation; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards*; D011507:Proteinuria / Q000175:diagnosis*; D011934:Reagent Strips
chemical_list: D011934:Reagent Strips