儿童保健专科护士体格测量数据的可信度研究

目的分析儿童保健专科护士体格测量数据的可信度,确定专科护士测量技术质量控制标准。方法选择重庆医科大学附属儿童医院儿童保健科健康体检的0～12岁儿童为研究对象。1名从事儿童体格测量的副主任护师为测量专家,另1名有1年以上体格测量工作经验的专科护士为对照。分别测量头围、身长（高）、顶臀长（坐高）及胸围4项体格指标1次,记录测量数据。分为〈1岁、～3岁和≥3岁组。计算测量技术误差（TEM）、测量差异均值（MAD）、可信度系数（R）和组间相关系数（ICC）等可信度指标,比较不同体格指标和不同年龄组间可信度的差异。结果 2006年3～10月549名儿童完成了测量,其中〈1岁组224名,～3岁198名,≥3岁127名。①头围、身长（高）、顶臀长（坐高）及胸围的MAD分别为0.17、0.35、0.49和0.64cm;TEM分别为0.16、0.34、0.46及0.59cm,R均为1.00,ICC为0.95～1.00。②各年龄组头围和胸围的MAD差异无统计学意义;〈1岁组和≥3岁组身长（高）的MAD差异有统计学意义;〈1岁、～3岁与≥3岁组顶臀长（坐高）的MAD差异有统计学意义。结论专科护士总体测量技术较好,测量差异均在允许范围内。头围测量的可信度最高,其次是身长（身高）和顶臀长（坐高）,胸围测量不易准确。规范的测量工具、统一的测量方法及专业的测量者是体格测量数据可靠的前提。

The reliability of pediatric clinical anthropometric data collected by child primary health care nurses

Objective To assess the reliability of pediatric clinical anthropometric data collected by child primary health care nurses in Chongqing,China.Methods Children＇s anthropometric measurements including head circumference,length（height）,crown-rump length（sitting-height）and chest circumference were analyzed.Two primary health care nurses obtained the four measurements twice using conventional methods in clinic and they were masked each others＇ measurements.Children were grouped into younger than one year old,one to three years old and older than three years old.The interexaminer mean absolute differences（MAD）,technical error of measurements（TEM）,coefficient of reliability（R）and intraclass correlation of coefficients（ICC）were calculated.Results Five hundred and forty-nine children aged 0 to 12 years were enrolled.The total MAD for head circumference,length（height）,crown-rump length（sitting-height）and chest circumference were 0.17,0.35,0.49 and 0.64 cm,respectively.The TEMs were 0.16,0.34,0.46 and 0.59 cm,respectively.The total R was 1.00,and ICC ranged 0.95-1.00.The MADs for head circumference and chest circumference were not significantly different among age groups.There was significant difference in MAD of length（height）between younger than one year old and older than three years old groups.There was significant difference in MAD of crown-rump length（sitting-height）between younger than 1 year old group and 3 years old group and older than 3 years old group.Conclusions These findings indicated that the anthropometric data collected by child primary health care nurses were under good in quality control.These findings also suggested that head circumference was the most reliable measurement,followed by length（height）,whereas chest circumference was the least reliable measurement.In order to obtain more reliable anthropometric data,it is important to use the standard anthropometric equipments and measurement methods,to employ experienced anthropometrists in clinical works.