Article Text

  1. L. R. Foster,
  2. L. Hynan,
  3. J. M. Anderson
  1. UT Southwestern, Dallas, TX


Background The Apgar score was developed to evaluate the physical condition of neonates after delivery, and assignment was done in real time by an observer to help guide the need for resuscitation. To our knowledge, the interrater reliability (IRR) of this scoring tool has not been investigated.

Objective To describe the IRR of 1- and 5-minute Apgars scored in real time.

Methods A digital video recorder was used to record high-risk resuscitations; consent was obtained and the study was approved by the Internal Review Board. Twenty recorded resuscitations were selected; the video recordings at 1 and 5 minutes were cropped to 15 seconds each. Ten practitioners (2 senior pediatric residents, 2 pediatric nurse practitioners, 2 neonatal nurse practitioners, 2 neonatal fellows, and 2 neonatal attending physicians) with 1 to 16 years experience in Apgar scoring volunteered to assign Apgar scores to the 1- and 5-minute video recordings. No information was given about the delivery, birth history, or outcome of the subjects in the video. Scores were confidentially recorded on a standardized form after each 15-second video clip. The Apgar score assigned in the delivery room was used as the gold standard and percent agreement, using an absolute agreement definition, was calculated for all raters.

Results Comparison of 10 raters. The Apgar scoring tool demonstrates high internal consistency (measured by Cronbach's alpha) of 0.986.

Conclusion The Apgar scoring tool demonstrates strong internal consistency and IRR at both 1 and 5 minutes when experienced raters assign Apgar scores in real time. The 1-minute assessment of color had the lowest IRR. Because Apgar scores are not typically assigned in real time, the impact retrospective scoring has on IRR and internal consistency needs to be investigated.

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