Concordance of expert clinicians' interpretations of the newborn's true physiological state.

Abstract

BackgroundMany physiological aspects of the neonatal transition after birth are unobservable because relevant sensors do not yet exist, compromising clinicians’ understanding of a neonate’s physiological status. Given that a neonate’s true physiological state is currently unavailable, we explored the feasibility of using clinicians’ degree of concordance as an approximation of the true physiological state.MethodsTwo phases of structured interviews were conducted. In Phase 1 (N = 8) and Phase 2 (N = 12), we presented neonatal experts with eight graphical trajectories of real newborns’ heart rate and oxygen saturation values in the first 10–15 min after birth. We elicited the participants’ interpretations of potential underlying physiological conditions that could explain the vital sign patterns.ResultsThe global differential diagnosis data for each phase produced the same pattern of results: (1) four trajectories produced a substantial degree of concordance among clinicians (61–80%) and (2) four trajectories produced a strong degree of concordance among clinicians (81–100%).ConclusionsIt is possible to achieve a strong degree of concordance among neonatal experts’ interpretations of newborn trajectories. Thus, using the degree of concordance as an approximation of the neonate’s true physiological state in resuscitation after birth may be a promising direction to explore for cognitive aid design.Impact Differential diagnoses with a good degree of concordance among expert neonatal clinicians could potentially substitute in part for the direct measurement of key physiological and anatomical variables of the neonatal transition, which is currently unavailable.The concordance of clinicians’ judgements or inferences with regards to the true physiological state of the newborn during resuscitation after birth has never been explored.The findings provide a crucial first step toward using consensus of neonatal experts’ judgements in the design of a cognitive aid to support clinicians’ management of the newborns who require resuscitation after birth.