Comparison of visual and computerized interpretation of nonstress test results in a randomized controlled trial,

Objective: This study tested the null hypothesis that the number of fetal surveillance tests and perinatal outcomes would not differ statistically between pregnancies randomized to visual or computerized interpretation of antepartum nonstress test results. Study Design: A prospective, randomized controlled trial was conducted, which required a sample size of 404 patients. By using a random-number table with assignment codes concealed in opaque envelopes, half of the patients were randomized to computerized interpretation of nonstress test results and half to standard visual interpretation of nonstress test results. The amount of antepartum testing and the perinatal outcome were measured and compared between the groups. Logistic regression analysis was used to control for maternal risk factors while morbidity differences between the 2 groups were assessed. Results: The 2 randomized groups were similar at baseline, but the computerized interpretation group had significantly fewer biophysical profiles compared with the visual interpretation group (1.3 ± 1.8 vs 1.9 ± 2.1; P = .002). The patients in the computerized interpretation group spent less time per test than patients in the visual interpretation group (12 vs 20 minutes; P = .038). After the 5 pregnancies with congenital anomalies were excluded, the overall perinatal outcome was similar in the 2 groups. The computerized interpretation group, however, had a slightly lower proportion of infants who required ≥2 days of neonatal intensive care (7.4% vs 12.4%; P = .086; odds ratio, 0.56; 95% confidence interval, 0.29-1.09). The average number of neonatal intensive care days was also slightly lower in the computerized interpretation group (0.4 vs 0.9; P = .105). Neither of these variables was statistically significant. Conclusions: Computerized interpretation of nonstress test results is associated with fewer additional fetal surveillance examinations, less time spent in testing, and a similar length of stay in the neonatal intensive care unit compared with standard visual interpretation. (Am J Obstet Gynecol 1999;181:1254-8.)