title: Variability in Apgar Score Assignment among Clinicians: Role of a Simple Clarification.
abstract: ObjectiveWe aimed to evaluate variability in Apgar score (AS) assignment among health care providers (HCPs) and to evaluate whether a simple clarification improves accuracy and consistency of AS assignment.Study DesignAn electronic questionnaire survey was provided to pediatric residents, nurse practitioners, neonatal fellows, and faculty in level III neonatal intensive care unit and major academic centers in the United State to assign AS for three clinical scenarios. Next, we provided a simple clarification on various components of AS. After review of clarification, responders were asked to provide AS for the same scenarios. We also sought the opinion of responders on the subjectivity of five components of AS.ResultsA total of 107 responses were collected. Correct assignment before and after clarification improved significantly: heart rate (78 vs. 90%,p= 0.02), reflex (63 vs.75%,p= 0.06), and breathing (82 vs. 96%,p= 0.003). Correct scoring for color and tone were 86 and 67%, respectively. Interobserver agreement improved significantly after clarification.ConclusionThere was variability among HCPs for AS assignment, with improvement in correct response as well as consistency after a simple clarification. Availability of this clarification, along with the AS table in delivery room, will improve the correct assignment and consistency of AS for high-risk infants.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Sabhya
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Girija
authors.initials: G
authors.lastname: Natarajan
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Karnati
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Meghan
authors.initials: M
authors.lastname: Dwaihy
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Bo
authors.initials: B
authors.lastname: Wang
authors.affiliation: Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chawla
mesh_terms: D001034:Apgar Score; D003490:Cyanosis; D005180:Faculty, Medical; D005257:Fellowships and Scholarships; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007396:Internship and Residency; D009129:Muscle Tonus; D009359:Neonatology / Q000193:education*; D009722:Nurse Practitioners; D015588:Observer Variation; D010372:Pediatrics / Q000193:education*; D012018:Reflex; D012119:Respiration