title: Comparing grades of urgency for classification of cesarean delivery.
abstract: 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.
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands. j.van_dillen@lumc.nl
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Dillen
authors.forename: Marijn
authors.initials: M
authors.lastname: Diesch
authors.forename: Joke
authors.initials: J
authors.lastname: Schutte
authors.forename: Joost
authors.initials: J
authors.lastname: Zwart
authors.forename: Ron
authors.initials: R
authors.lastname: Wolterbeek
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: 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