title: Interobserver reliability of microscopic assessment of saline-prepared vaginal fluid.
abstract: OBJECTIVE
  To determine the interobserver reliability of microscopic assessment of saline-prepared vaginal fluid.
  
  
  METHODS
  Blind-paired microscopic assessments of saline-prepared vaginal fluid collected from women presenting for gynecologic care were compared using concordance and weighted chance-corrected agreement statistics (κ).
  
  
  RESULTS
  Vaginal fluid from 105 women was collected and examined by 65 distinct observer pairs. The mean age of participants was 39 years, with vaginal itch (29%) followed by discharge (21%) as the most common presenting complaints. The κ value for microscopic findings ranged from 0.28 (normal flora) to 0.50 (clue cells >20%). The κ value for vaginitis diagnoses ranged from 0.25 (atrophic vaginitis) to 0.45 (bacterial vaginosis).
  
  
  CONCLUSIONS
  Interobserver agreement in the microscopic assessment of vaginal fluid is at best moderate. The value of microscopy in the diagnosis of vaginitis is uncertain, and effort should be directed to improve the precision of this tool.
authors.affiliation: Department of Obstetrics and Gynecology, Dartmouth Medical School, Lebanon, NH 03756, USA. James.L.Whiteside@Hitchcock.org
authors.forename: James L
authors.initials: JL
authors.lastname: Whiteside
authors.forename: Themarge A
authors.initials: TA
authors.lastname: Small
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
authors.forename: Cara L
authors.initials: CL
authors.lastname: Grimes
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Shore
authors.forename: Debra
authors.initials: D
authors.lastname: Birenbaum
mesh_terms: D000328:Adult; D001826:Body Fluids / Q000502:physiology*; D005260:Female; D006801:Humans; D008853:Microscopy / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012965:Sodium Chloride; D014621:Vagina / Q000382:microbiology*; D014627:Vaginitis / Q000175:diagnosis* / Q000453:epidemiology; D016585:Vaginosis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
chemical_list: D012965:Sodium Chloride