Westgard J O, Burnett R W
Department of Pathology, University of Wisconsin, Madison 53792.
Clin Chem. 1990 Sep;36(9):1629-32.
Current performance criteria for analytical methods are often based on recommendations developed many years ago. A common criterion for imprecision requires that two times the standard deviation (s) of the method be less than the allowable total error (TEa). Unfortunately, when this criterion is minimally satisfied, commonly used control procedures cannot achieve reliable detection of medically important errors. Studies of the power functions for statistical quality-control (QC) procedures show that the magnitude of medically important errors must be at least 3s to fall near the plateau of the power curves and be readily detected by current QC procedures. For methods that just meet the precision criterion 2s less than TEa, however, medically important errors will fall on the rising portion of the power curves and typically be detected less than half of the time. From a "reverse engineering" perspective, the 2s less than TEa criterion is inadequate because it does not allow for the known performance limitations (lack of sensitivity) of commonly used control procedures. A strong case can be made for using a criterion of at least '4s less than TEa, which calls for a twofold improvement in imprecision over, the current minimum requirements. This recommendation is consistent with current industrial guidelines for process capability and would lead to more reliable detection of medically important errors.
当前分析方法的性能标准通常基于多年前制定的建议。不精密度的一个常见标准要求方法的两倍标准差(s)小于允许总误差(TEa)。不幸的是,当这个标准刚刚得到满足时,常用的控制程序无法实现对医学上重要误差的可靠检测。对统计质量控制(QC)程序的功效函数研究表明,医学上重要误差的幅度必须至少为3s,才能落在功效曲线的平稳段附近,并能被当前的QC程序轻易检测到。然而,对于那些刚好满足精度标准(2s小于TEa)的方法,医学上重要的误差将落在功效曲线的上升段,通常检测到的时间不到一半。从“逆向工程”的角度来看,2s小于TEa的标准是不够的,因为它没有考虑到常用控制程序已知的性能限制(缺乏敏感性)。有充分的理由使用至少4s小于TEa的标准,这要求不精密度比当前的最低要求提高两倍。这一建议与当前的工业过程能力指南一致,将导致对医学上重要误差的更可靠检测。