title: Accuracy of fetal heart-rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development compared with computer-aided interpretation.
abstract: OBJECTIVE
  To evaluate the accuracy of fetal heart rate variability interpretation by obstetricians using the criteria of the National Institute of Child Health and Human Development (NICHD), compared with computer-aided analysis as a gold standard.
  
  
  METHODS
  One hundred and fourteen panels of fetal heart-rate tracings derived from electrocardiogram via scalp electrodes obtained from women with high-risk pregnancies during the intrapartum period. The tracings were interpreted using computer analysis and recorded as a gold standard. The same tracings were distributed to six observers: three residents in the third year of training and three faculty members. All observers blindly interpreted the fetal heart-rate variability without the knowledge of the computer analysis. The main outcome measures were: (i) the accuracy of fetal heart-rate variability interpretation by obstetricians using the NICHD criteria compared with computer-aided analysis was presented as a percentage value; and (ii) the agreement of fetal heart-rate variability interpretation between the obstetricians and the computer analysis using the NICHD criteria was presented as a kappa-value.
  
  
  RESULTS
  When using the computer analysis as a gold standard, the accuracy of fetal heart-rate variability interpretation in the residents group was 81.58%, 86.84% and 82.46%, respectively, with a mean of 83.62%, whereas the accuracy of the faculty members was 79.82%, 67.54% and 79.82%, respectively, with a mean of 75.73%. kappa-values, representing the agreement of interpretation, were 0.70, 0.78 and 0.72, with a mean of 0.73 +/- 0.04 among the residents, and 0.67, 0.50 and 0.68, with a mean of 0.62 +/- 0.10 among the faculty members. Agreements in the two groups were not significantly different (Student's t-test, P=0.14).
  
  
  CONCLUSIONS
  Using the NICHD criteria, the accuracy and agreement of fetal heart-rate variability interpretation in the third-year residents and faculty members are substantial. There was no difference between the groups with regard to the agreement of fetal heart-rate variability interpretation.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. ttongson@mail.med.cmu.ac.th
authors.forename: Theera
authors.initials: T
authors.lastname: Tongsong
authors.forename: Arunsri
authors.initials: A
authors.lastname: Iamthongin
authors.forename: Chanane
authors.initials: C
authors.lastname: Wanapirak
authors.forename: Wirawit
authors.initials: W
authors.lastname: Piyamongkol
authors.forename: Supatra
authors.initials: S
authors.lastname: Sirichotiyakul
authors.forename: Pongrak
authors.initials: P
authors.lastname: Boonyanurak
authors.forename: Teerapong
authors.initials: T
authors.lastname: Tatiyapornkul
authors.forename: Chanthawat
authors.initials: C
authors.lastname: Neelasri
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000196:embryology; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000592:standards; D005260:Female; D005323:Fetal Monitoring / Q000592:standards*; D006801:Humans; D007743:Labor, Obstetric; D008503:Medical Staff; D009316:National Institutes of Health (U.S.); D015588:Observer Variation; D009774:Obstetrics / Q000193:education / Q000592:standards*; D011237:Predictive Value of Tests; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012815:Signal Processing, Computer-Assisted; D013785:Thailand; D014481:United States