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The role of observer error in antenatal dipstick proteinuria analysis
S C Bell1, A W Halligan, A Martin
1Department of Obstetrics and Gynaecology, University of Leicester, UK.
Objective:
To determine the role of inter-observer error and the influence of training upon dipstick urine analysis.
Design:
A two phase observational and training study.
Methods:
Five standard solutions of serum albumin were used to test the accuracy of midwives and nursing auxiliaries involved in dipstick urine analysis at a maternity hospital. The standard solutions were chosen such that they should have resulted in negative (n = 2) and positive (n = 3) dipstick test results, respectively.
Setting:
A teaching maternity hospital and academic department of obstetrics and gynaecology.
Participants:
Twenty midwives, 20 nursing auxiliaries and nine laboratory technicians.
Results:
For the two nonproteinuric solutions, a higher false positive rate was observed for nursing auxiliaries (40% and 55%), compared with midwives (5% and 30%) (P = 0.020 and P = 0.20, respectively). Before training, laboratory technicians recorded high false positive rates (67% and 89%), but after training these were reduced to 0% and 22% (P = 0.25 and P = 0.023, respectively). Both nursing auxiliaries and midwives recorded false negative rates of between 10% and 45% for the three proteinuric solutions.
Conclusions:
Observer error may be reduced by assigning midwives to urine dipstick analysis or by the implementation of directed training. Classification of pre-eclampsia or other hypertensive diseases of pregnancy on the basis of the presence and degree of proteinuria should be confirmed with a 24-hour quantitative protein collection.