Measurement
error for ultrasound fetal biometry performed by paramedics in rural Bangladesh
Auteur(s) / Author(s)
NEUFELD L. M. (1) ; WAGATSUMA Y. (2) ; HUSSAIN R. (3) ; BEGUMS M. (4) ; FRONGILLO E.
A. (5) ;
Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
(1) Division of Nutritional Epidemiology, National Institute of
Public Health, Cuernavaca, MEXIQUE
(2) Graduate School of Comprehensive Human Sciences, University of
Tsukuba, Tsukuba, JAPON
(3) Institute of Nuclear Medicine & Ultrasound, Dhaka,
BANGLADESH
(4) Centre for Health and Population Research, ICDDR,B, Dhaka,
BANGLADESH
(5) Department of Health Promotion, Education and Behavior,
University of South Carolina, Columbia, SC, ETATS-UNIS
Abstract
Objectives To document the accuracy and precision of sonographic
fetal biometry performed by nine paramedics from rural Bangladesh. Methods
Paramedics underwent intensive training (6 weeks) including hands-on practice
then underwent a series of standardization exercises. Measurements of each
fetus were taken by a highly-trained medical doctor (study supervisor) and the
nine paramedics. Crown-rump length (CRL) in fetuses of less than 10 weeks'
gestation, and biparietal diameter (BPD), occipitofrontal diameter, head and
abdominal circumference (AC) and femur diaphysis length (FL) were measured
twice using standard procedures by each paramedic and the medical doctor for
each fetus, with at least 20 min between them. Precision was quantified using
variance components analysis; the intraobserver error for each of the
paramedics was calculated by comparing repeat measurements taken on the same
participant, and the measurements obtained by each individual paramedic were
also compared with those taken by the others (interobserver error). Accuracy
was estimated by comparing the mean of the two measures taken by each paramedic
to those taken by the study supervisor using paired t-tests. Bland-Altman plots
were used to visually assess the relationship between precision of repeat
measurements (intraobserver error) and fetal size. Results A total of 180
women, at 7 to 31 weeks' gestation, participated in the study. Intraobserver
error of the measurements obtained by the paramedics, expressed as the mean SD,
ranged from 0.97 mm for BPD in the first trimester to 7.25 mm for AC in the
third trimester, and was larger than the interobserver error (i.e. accounting
for a greater proportion of total variance) for most measurements.
Interobserver error ranged from 0.00 mm for FL to 3.36 mm for AC, both in the
third trimester. For all measurements except CRL, intraobserver error increased
with increasing fetal size. The measurements obtained by the paramedics did
show some statistically significant differences from those obtained by the
study supervisor, but these were relatively small in magnitude. Conclusions
Both inter- and intraobserver measurement errors were within the range reported
in the literature for studies conducted by technical staff and medical doctors.
With intense training, paramedics with no prior exposure to ultrasonography can
provide accurate and precise measures of fetal biometry.
Journal Title
Ultrasound in
obstetrics & gynecology ISSN
0960-7692
Source
2009, vol. 34, no4, pp. 387-394 [8
page(s) (article)] (19 ref.)
Language
Anglais
Publisher
Wiley, Chichester, ROYAUME-UNI (1991) (Revue)
English Keywords: Asia; Obstetrics; Gynecology; Standardization; Biparietal
diameter; Accuracy; Bangladesh; Rural environment; Paramedic; Fetus; Ultrasound; Error; Echography; Sonography;
Localisation / Location
INIST-CNRS, Cote INIST : 26580, 35400017002115.0050