Interpretation of cardiotocogram (CTG) is a difficult task since its evaluation is complicated by a great inter- and intra-individual variability. Previous studies have predominantly analyzed clinicians' agreement on CTG evaluation based on quantitative measures (e.g. kappa coefficient) that do not offer any insight into clinical decision making. In this paper we aim to examine the agreement on evaluation in detail and provide data-driven analysis of clinical evaluation. For this study, nine obstetricians provided clinical evaluation of 634 CTG recordings (each ca. 60min long). We studied the agreement on evaluation and its dependence on the increasing number of clinicians involved in the final decision. We showed that despite of large number of clinicians the agreement on CTG evaluations is difficult to reach. The main reason is inherent inter- and intra-observer variability of CTG evaluation. Latent class model provides better and more natural way to aggregate the CTG evaluation than the majority voting especially for larger number of clinicians. Significant improvement was reached in particular for the pathological evaluation - giving a new insight into the process of CTG evaluation. Further, the analysis of latent class model revealed that clinicians unconsciously use four classes when evaluating CTG recordings, despite the fact that the clinical evaluation was based on FIGO guidelines where three classes are defined.
Keywords: Biomedical informatics; Cardiotocography; Decision making; Fetal heart rate; Latent class analysis; Observer variation.
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