Reliability of the Guide to Pregnancy Risk Grading of the Ontario Antenatal Record in assessing obstetric risk.
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OBJECTIVE: To assess the reliability of the Guide to Pregnancy Risk Grading of the Ontario Antenatal Record through evaluation of inter- and intra-observer agreement on the grading of obstetric risk. DESIGN: Retrospective chart review. SETTING: Urban community teaching hospital in Hamilton, Ont. PATIENTS: Obstetric charts of 77 women were randomly selected from those of all women who delivered at the hospital or were transferred before delivery to the regional perinatal centre between Apr. 1, 1987, and Mar. 31, 1988. Six family physicians and two obstetricians participated as chart reviewers. MAIN OUTCOME MEASURES: Agreement beyond chance (kappa [kappa] statistic) between (a) different reviewers, (b) the same reviewer at different times and (c) the majority of reviewers (majority risk grade) and the antenatal record. MAIN RESULTS: The kappa value for interobserver agreement ranged from 0.48 (95% confidence interval [CI] 0.34 to 0.62) to 0.51 (95% CI 0.36 to 0.66). For intraobserver agreement it was 0.69 (95% CI 0.37 to 1.0). Agreement between the majority risk grade and the risk grade last recorded in the antenatal record had a kappa value of 0.58 (95% CI 0.54 to 0.61). CONCLUSION: The guide possesses only modest reliability. Efforts should be made to make descriptions of risk factors more explicit and to improve the training of health care providers in the use of the guide in order to prevent errors in pregnancy risk assessment and resulting inappropriate patient care and misdirection of health care resources.
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