RESUMO
The osseous acetabular index (OAI) and cartilaginous acetabular index (CAI) is often used in diagnosing acetabular dysplasia (AD) in children. We examined the reliability of OAI and CAI in AD diagnostics and compared OAI measurements obtained from radiographs versus MRI. Four raters performed retrospective repeated measurements of the OAI and CAI on pelvic radiographs and MRI scans of 16 consecutive patients (mean age 5 years (2-8)) examined for borderline AD during a period of 2½ years. In MRI, the image selected for analysis by the raters was also registered. Spearman's correlation, scatter plots, and Bland-Altman (BA) plots were analysed for correlation between OAI on pelvic radiographs (OAIR) and MRI scans (OAIMRI), while intra- and interrater reliability was assessed for OAIR, OAIMRI, CAI, and MRI image selection using intraclass correlation coefficients (ICC). ICC values for inter- and intrarater reliability of OAIR, OAIMRI, and CAI were all above 0.65, with no significant differences observed. ICC values (CI) for individual raters' MRI image selection was 0.99 (0.998-0.999). The mean difference (95% CI) between OAIR and OAIMRI was -0.99 degrees (-1.84; -0.16), while the mean absolute difference (95% CI) between OAIR and OAIMRI was 3.68 degrees (3.17; 4.20). Absolute differences between OAIR and OAIMRI was independent of pelvic positioning or time interval between radiographs and MRI scans. OAI and CAI had high Intrarater reliability but mediocre interrater reliability. There was an absolute difference of 3.7 degrees in OAI between pelvic radiographs and MRI scans.
RESUMO
Most programs to reduce maternity deaths focus on hospital performance and general obstetric protocols. In communities where most mothers deliver at home, such strategies will not reduce avoidable deaths. The key concept in the actual intervention is to regard deliveries in poor rural communities as a trauma and to merge midwives and traditional birth attendants (TBAs) with an already existing and successful rural trauma rescue system. A total of 256 Cambodian careproviders, 41 health center midwives and paramedics, plus surgical teams at local hospitals were trained over a 2 year period. After completing the training program, the participants themselves rated their skills, confidence, and quality of team work by Visual Analog Scale measurement. The results demonstrate significant improvement, both for the TBAs and the certified midwives. The intervention results so far indicate that delivery life support training to rural careproviders increases their capacity to cope with emergency obstetric cases.