



@article {2238,
	title = {The limits of agreement and the intraclass correlation coefficient may be inconsistent in the interpretation of agreement},
	journal = {Journal of Clinical EpidemiologyJ. Clin. Epidemiol.},
	volume = {64},
	year = {2011},
	note = {Cited By (since 1996): 13Export Date: 21 November 2012Source: ScopusCODEN: JCEPEdoi: 10.1016/j.jclinepi.2009.11.010PubMed ID: 20189765Language of Original Document: EnglishCorrespondence Address: Costa-Santos, C.; Biostatistics and Medical Informatics Department, Faculty of Medicine, University of Porto, Al. Prof. Hern{\^a}ni Monteiro, 4200-319 Porto, Portugal; email: csantos@med.up.ptReferences: De Vet, H., Observer reliability and agreement (1999) Encyclopedia of Biostatistics, pp. 3123-3127;Ayres-De-Campos, D., Bernardes, J., Costa-Pereira, A., Pereira-Leite, L., Inconsistencies in expert{\textquoteright}s classification of cardiotocograms and subsequent clinical decision (1999) Br J Obstet Gynaecol, 106, pp. 1307-1310; 
Santos, C.C., Pereira, C.A., Bernardes, J., Agreement studies in obstetrics and gynaecology: Inappropriateness, controversies and consequences (2005) Br J Obstet Gynaecol, 112, pp. 667-669; 
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Bland, J.M., Altman, D.G., Statistical methods for assessing two methods of clinical measurement (1986) Lancet, 1, pp. 307-310; 
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Casey, B.M., McLntire, D.D., Leveno, K.J., The continuing value of the Apgar score for the assessment of newborn infants (2001) N Engl J Med, 344, pp. 467-471; 
Van De Riet, J.E., Vandenbussche, F.P., Le Cessie, S., Keirse, M.J., Newborn assessment and long-term adverse outcome: A systematic review (1999) Am J Obstet Gynecol, 180, pp. 1024-1029; 
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},
	month = {2011///},
	pages = {264 - 269},
	abstract = {Objective: To compare the interpretation of agreement in the prediction of neonatal outcome variables, using the limits of agreement (LA) and the intraclass correlation coefficient (ICC). Study Design and Setting: Three obstetricians were asked to predict neonatal outcomes independently based on the evaluation of intrapartum cardiotocographic tracings. Interobserver agreement was assessed with the LA and the ICC, and the results obtained were interpreted by six clinicians and six statisticians on a scale that established agreement as very poor, poor, fair, good, or very good. Results: Interpretation of the LA results was less consensual than the ICC results, with proportions of agreement of 0.36 (95\% confidence interval [CI]: 0.28-0.44) vs. 0.63 (95\% CI: 0.54-0.73), respectively. LA results suggested a fair to good agreement among obstetricians, whereas interpretation of ICC results suggested a poor to fair agreement. LA results were more plausible with reality, suggesting that obstetricians predicted neonatal outcomes better than randomly generated values, whereas it was not always the case with the ICC. Conclusions: LA and ICC can provide inconsistent results in agreement studies. Accordingly, in the absence of better strategies to assess agreement, both should be used for this purpose, but their results need to be interpreted with caution keeping their respective limitations in mind. {\textcopyright} 2011 Elsevier Inc. All rights reserved.},
	keywords = {Agreement, Apgar score, Cardiotocography, correlation coefficient, Female, Fetal Blood, human, Humans, Hydrogen-Ion Concentration, Infant, Newborn, intrapartum care, limit of agreement, newborn assessment, normal human, observer variation, Obstetrics, outcome variable, Pregnancy, Pregnancy Outcome, priority journal, reproducibility, Reproducibility of Results, review, statistical data interpretation, statistical parameters, Umbilical Arteries, Umbilical artery blood pH, umbilical cord blood},
	isbn = {08954356 (ISSN)},
	url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-78751646336\&partnerID=40\&md5=a64bd277d4122b8ce3affa5f3d5d68a5},
	author = {Costa-Santos, C. and Bernardes, J. and Ayres-de-Campos, D. and Costa, A. and Costa, C.}
}
