RELIABILITY OF THE GUIDE TO PREGNANCY RISK GRADING OF THE ONTARIO ANTENATAL RECORD IN ASSESSING OBSTETRIC RISK

Objective: To assess the reliability of the Guide to Pregnancy Risk Gr ading of the Ontario Antenatal Record through evaluation of inter- and intra-observer agreement on the grading of obstetric risk. Design: Re trospective chart review. Setting: Urban community teaching hospital i n 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 obstetr icians participated as chart reviewers. Main outcome measures: Agreeme nt beyond chance (kappa [kappa] statistic) between (a) different revie wers, (b) the same reviewer at different times and (c) the majority of reviewers (majority risk grade) and the antenatal record. Main result s: The kappa value for interobserver agreement ranged from 0.48 (95% c onfidence interval [CI] 0.34 to 0.62) to 0.51 (95% CI 0.36 to 0.66). F or 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 t he antenatal record had a kappa value of 0.58 (95% CI 0.54 to 0.61). C onclusion: The guide possesses only modest reliability. Efforts should be made to make descriptions of risk factors more explicit and to imp rove the training of health care providers in the use of the guide in order to prevent errors in pregnancy risk assessment and resulting ina ppropriate patient care and misdirection of health care resources.