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Medical Decision Making
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Management Decisions after Nonstress Testing

Marvin L. Hage

Evaluation of patient management after the utilization of a specific diagnostic test has been difficult to interpret from retrospective studies. Specifically, the impact of the interpretation of the diagnostic study, the environment where the test is performed, and the biases of the physician have been difficult to separate. In this study, agreement on first-choice management decisions by a national sample of obstetricians blinded to specific clinical information, based on interpretations of five nonstress tests, was low (kappa = 0.24 ± 0.02). The response "evaluate for delivery" was significantly different between "reactive" and "nonreactive" inter pretations. There was better management agreement among those respondents with more experience with nonstress testing; those from larger hospitals; and those who practiced at universities, HMOs, and military hospitals. The attitudes of individual respondents as mea sured by the first-choice goals of the test did not significantly influence overall management agreement. Reliability of management was less among physicians aged 50-59 years. There was no obvious national consensus regarding management following nonstress testing. Key words: nonstress test; management; reliability; kappa statistic. (Med Decis Making 7:97- 103, 1987)

Medical Decision Making, Vol. 7, No. 2, 97-103 (1987)
DOI: 10.1177/0272989X8700700206
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