Comparing grades of urgency for classification of cesarean delivery.
OBJECTIVE
To evaluate the agreement between the traditional binary system and a new system for classifying urgency of cesarean delivery among obstetricians in The Netherlands and Belgium.


METHODS
A total of 212 obstetricians were requested to grade a list of 18 obstetric scenarios using 3 classification systems: traditional binary classification; a new classification using 4 grades of urgency without additional interpretation; and the new classification with additional interpretation. Agreement was assessed by weighted kappa.


RESULTS
Seventy-nine obstetricians responded (The Netherlands 62.2%, Belgium 9.9%). There was substantial agreement among them for all 3 classification systems (kappa=0.71, traditional classification; kappa=0.70, new classification; kappa=0.67, new classification with additional interpretation).


CONCLUSIONS
The traditional binary system and the new classification of cesarean delivery based on 4 grades of urgency, with and without additional interpretation, have similar but relatively low interobserver agreement. We suggest that the new classification should be used, but future studies are necessary to evaluate the effect of this implementation.
van Dillen
Jeroen
J
Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. j.van_dillen@lumc.nl
Diesch
Marijn
M
Schutte
Joke
J
Zwart
Joost
J
Wolterbeek
Ron
R
van Roosmalen
Jos
J
D001530:Belgium; D002585:Cesarean Section / Q000145:classification*; D004630:Emergencies / Q000145:classification*; D005260:Female; D006801:Humans; D009426:Netherlands; D015588:Observer Variation; D011247:Pregnancy; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires