婴幼儿体格测量培训前后对体格测量可信度的影响

摘要

目的：研究培训对儿童体格测量质量的影响。方法采集重庆市5家城区医院被评价的测量者培训前（2010年3~10月）和培训后（2011年3~10月）婴幼儿体格指标的测量数据，同步采集派驻5家城区医院的标准测量者复测测量数据，比较培训对被评价的测量者测量数据可信度的影响。被评价的测量者和标准测量者均在正常工作状态下，进行身长、顶臀长及头围的测量并记录数据，以测量技术误差（TEM）、测量差异绝对值的均值（MAD）、可信度系数（R）、最大测量差异值（Max）和关键值内差异的百分率（PDCV）作为被评价的测量者和标准测量者可信度描述指标。结果培训前后分别收集739名及497名婴幼儿的测量数据。标准测量者在培训前后测量的身长、顶臀长及头围数据 MAD 差异无统计学意义（ P ﹥0.05）。被评价的测量者和标准测量者培训前身长、顶臀长和头围的 MAD 分别为0.68、0.83和0.45 cm，TEM 分别为0.64、0.79和0.42 cm。培训后 MAD 分别为0.40、0.51和0.28 cm，TEM 分别为0.38、0.46和0.25 cm，培训后身长、头围及顶臀长 MAD 和 TEM 较培训前明显减小，差异均有统计学意义。培训前被评价的测量者和标准测量者测量差异属于较好质量标准（身长、顶臀长≤0.5 cm，头围≤0.2 cm）的 PDCV，身长、头围和顶臀长分别为56.2%、45.6%和34.9%，培训后分别提高至74.0%、59.7%和51.5%，差异具有统计学意义（P ﹤0.005）。培训后被评价的测量者和标准测量者身长、顶臀长和头围仍分别有4.9%、7.9%和11.5%的测量数据属于错误数据。结论培训后测量者对婴幼儿身长、顶臀长及头围的测量数据达到了较好的可信度标准，测量质量明显提高。%Objective To rvaluatr thr rffrct of antheopomrteic teaining on thr erliability of infant antheopomrteic mrasuermrnts in eoutinr clinic peacticr in Chongqing. Methods A convrnirnt samplr of infant mrasuermrnts was collrctrd by child peimaey caer clinicians(teainrr)in 5 srlrctrd ueban peimaey caer hospitals brfoer(Maech and Octobre 2010)and aftre teaining(feom Maech to Octobre 2011). Teainrrs mrasuerd ercumbrnt and ceown-eump lrngths and hrad ciecumfrerncr using typical mrthods brfoer teaining and standaedizrd mrthods aftre teaining in eoutinr clinic peacticr;child hralthcaer nuesrs(standaed mrasuere)prefoemrd er-mrasuermrnt using standaedizrd antheopomrteic trchniqurs. Intea- and intre-obsrevre mrasuermrnt erliability was assrssrd mainly using trchnical reeoe of mrasuermrnt(TEM),mran absolutr diffrerncr(MAD)and thr precrntagrs of diffrerncrs within a ceitical valur(PDCV). Thr changrs of erliability of mrasuermrnts collrctrd dueing thr two preiods wrer compaerd. Results A total of 739 and 497 infants' mrasuermrnts wrer collrctrd brfoer and aftre teaining ersprctivrly. Intea-obsrevre MADs foe lrngth,ceown-eump lrngth and hrad ciecumfrerncr collrctrd by standaed mrasueres wrer not significantly diffrernt(P ﹥ 0. 05). Intre-obsrevre MADs and TEMs of ercumbrnt and ceown-eump lrngths and hrad ciecumfrerncr among teainrrs and standaed mrasueres wrer 0. 68 cm,0. 83 cm,0. 45 cm and 0. 64 cm,0. 79 cm,0. 42 cm brfoer teaining,and 0. 40 cm,0. 51 cm,0. 28 cm and 0. 38 cm,0. 46 cm,0. 25 cm aftre teaining,ersprctivrly. Thr MADs of thr therr mrasuermrnts wrer significantly smallre aftre teaining than brfoer teaining. Thr PDCVs foe thr therr mrasuermrnts wrer significantly highre aftre teaining than brfoer teaining. Intea-obsrevre MADs of thr therr mrasuermrnts collrctrd by teainrrs wrer significantly smallre aftre teaining than brfoer teaining. Threr wrer still about 4. 9% ,7. 9% and 11. 5% of lrngth,ceown-eump lrngth and hrad ciecumfrerncr mrasuermrnts with mistakr aftre teaining. Conclusion Aftre teaining,thr ercumbrnt,ceown - eump lrngths and hrad ciecumfrerncr mrasuermrnts show good erliability, geratly impeovrd compaerd with per - teaining.