Knowledge of an adverse neonatal outcome significantly increased the likelihood of obstetricians judging care as below the standard of care compared to a healthy outcome (72.4% vs 37.1%; RR 2.0).
RCT (n=128)
Randomly assigned
Yes
Does knowledge of an adverse neonatal outcome increase the likelihood of obstetricians judging care as below the standard of care?
Knowledge of adverse outcomes significantly biases obstetricians' retrospective interpretation of fetal heart rate tracings and quality of care judgments.
Relative Risk: 2 (95% CI 1.4–2.8)
Absolute Event Rate: 72.4% vs 37.1%
p-value: p=0.0001
Objective: To determine whether obstetricians evaluating management decisions for abnormal fetal heart rate (FHR) patterns are more likely to judge care as below the standard of care when informed of an adverse neonatal outcome rather than a healthy outcome. Study design: Obstetricians from four academic institutions participated in a study involving three clinical scenarios with abnormal intrapartum FHR tracings. Each case included clinical details, FHR tracing segments, and neonatal outcomes. Participants were asked to categorize the FHR tracing, assess the timing of cesarean delivery (CD), and evaluate the quality of care. All participants received identical information for the first two cases. For the third case, participants received identical intrapartum data and FHR tracings but were randomly assigned to 1 of 2 neonatal outcomes (healthy vs adverse). Results: A total of 128 obstetricians participated. There were no differences in assessments for the first 2 cases. For the third case, knowledge of an adverse neonatal outcome was associated with more severe categorization of the FHR tracing (p=0.002), a greater likelihood of perceiving that CD was performed too late (79.3% vs 48.6%; p=0.0001; RR, 1.6 95% CI, 1.2–2.2), and a higher likelihood of judging care as below the standard of care (72.4% vs 37.1%; p=0.0001; RR, 2.0 95% CI, 1.4–2.8). Conclusion: Knowledge of an adverse neonatal outcome altered the interpretation of identical FHR tracings and doubled the likelihood of judging obstetrical care as below the standard of care, demonstrating the considerable influence of hindsight and outcome bias on retrospective clinical assessment.
Blackwell et al. (Mon,) conducted a rct in Fetal heart rate interpretation and obstetric care quality assessment (n=128). Knowledge of an adverse neonatal outcome vs. Knowledge of a healthy neonatal outcome was evaluated on Judging care as below the standard of care (RR 2.0, 95% CI 1.4-2.8, p=0.0001). Knowledge of an adverse neonatal outcome significantly increased the likelihood of obstetricians judging care as below the standard of care compared to a healthy outcome (72.4% vs 37.1%; RR 2.0).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: