Interobserver variability of the 5-minute Apgar score

Objectives

To assess interobserver variability of Apgar scores assigned with video recordings of neonatal resuscitation (AS_video) and compare the scores assigned by observers of videos to the Apgar score given by staff attending the delivery (AS_del).

Study design

Ten-second clips of 30 newborns taken at 5 minutes were shown to observers. Infants were 23 to 40 weeks’ gestation, received varying degrees of resuscitation, and were monitored with pulse oximetry. Forty-two observers (neonatal/obstetric medical/nursing staff) scored infants’ respiratory effort, muscle tone, reflex irritability, and color. The value for heart rate was assigned from the oximeter, which was masked in all clips. All 42 AS_video and the AS_del were represented graphically for each infant. Interobserver reliability was assessed by use of a variance components model.

Results

AS_video varied widely between observers. Variability was large for all 4 elements of the score observers assigned and was seen irrespective of the infant’s level of illness. AS_del was greater than AS_video in most cases, on average by 2.4 points. There was no evidence that the level of discrepancy was substantially different between groupings of staff.

Conclusion

The Apgar score has poor interobserver reliability. More objective and precise measures of newborns’ condition are required.

Abbreviations: AS_del, Apgar score given by staff attending the delivery, AS_video, Apgar scores assigned by observers of video recordings, HR, Heart rate, PPV, Positive predictive value