Risk stratification for preeclampsia: evaluation of residents’ practice and development of a clinical application

Abstract

Objective: To evaluate the diagnostic agreement and completeness of preeclampsia risk stratification performed by Family and Community Medicine residents in Family Health Units in Patos-PB, Brazil, as well as to assess the usability of a clinical decision-support application. Methods: A cross-sectional quantitative study was conducted through documentary analysis of electronic medical records of pregnant women with gestational age under 12 weeks followed in Primary Health Care. The recorded stratification was compared with the classification obtained through an application based on the protocol of the Brazilian Network of Studies on Hypertension in Pregnancy. Classification adequacy, completeness of records, and diagnostic agreement were evaluated using the weighted Kappa coefficient. Odds Ratio, 95% confidence interval, and Fisher’s exact test were also used. Usability was assessed using the System Usability Scale. Results: A total of 136 pregnant women were analyzed. Agreement between classifications was 57.9% (Kappa=0.28), with a mean completeness of 29.6%. Obesity and maternal age ≥35 years were significantly associated with risk underclassification. The application achieved the maximum usability score. Conclusion: A high frequency of risk underclassification and low completeness of records were observed, compromising the early identification of high-risk pregnant women.