Massachusetts General Hospital, Cardiac Ultrasound Laboratory, Cardiology Division, Harvard Medical School, Boston, Massachusetts 02114, USA.
JACC Cardiovasc Imaging. 2011 Aug;4(8):821-9. doi: 10.1016/j.jcmg.2011.06.004.
This study sought to determine whether a formalized teaching intervention could reduce the interobserver variability (IOV) in visual estimation of left ventricular ejection fraction (LVEF) within a group of sonographers and physicians with a spectrum of experience.
Precise and reliable echocardiographic assessment of LVEF is necessary for clinical decision-making and minimizing duplicative testing. Skill in the visual estimation of LVEF varies depending on experience and is critical for corroborating EF quantification. IOV may also lead to inconsistency if multiple readers are assessing the EF on serial exams.
Fourteen cases of 2-dimensional echocardiograms were shown to 25 participants who estimated the EF based on a complete assessment of LV wall motion including parasternal, short-axis, apical, and subcostal views. The cases represented a spectrum of EF range, image quality, and clinical context. Following the initial interpretations, participants underwent a teaching intervention involving tutorial review of reference cases and group discussion of each case with determination of the EF guided by quantitative measure (biplane Simpson method). Three months after the teaching intervention, 14 new cases were shown to the 25 participants following the same methodology.
IOV was quantified before and after the teaching intervention with the use of a 3-factor, nested analysis of variance. The factors were: observer, patient, and pre- and post-intervention (time). The analysis of variance showed that the intervention reduced the IOV for the 25 readers between the pre- and post-intervention assessments (F = 2.8, p = 0.007). The IOV decreased from ± 14% EF prior to intervention to ± 8.4% EF following intervention (a 40% reduction in IOV).
In a large echocardiography laboratory with a wide range of training levels and experience, a simple, formalized teaching intervention can successfully diminish IOV of LVEF assessment. This intervention provides not only discrete quality measures, but also serves as a practical tool to document and improve quality of reporting, potentially reducing clinical inefficiencies and repeat testing.
本研究旨在确定在一组具有不同经验水平的超声医师和医生中，通过正式的教学干预是否可以减少左心室射血分数（LVEF）视觉评估的观察者间变异性（IOV）。
精确和可靠的超声心动图 LVEF 评估对于临床决策和减少重复测试是必要的。LVEF 的视觉评估技能取决于经验，对于证实 EF 定量至关重要。如果多个读者在连续检查中评估 EF，则 IOV 也可能导致不一致。
向 25 名参与者展示了 14 例 2 维超声心动图，参与者根据 LV 壁运动的全面评估（包括胸骨旁、短轴、心尖和肋下视图）来估计 EF。这些病例代表了 EF 范围、图像质量和临床背景的一个范围。在初始解释后，参与者接受了教学干预，包括参考病例的教程复习和对每个病例的小组讨论，并通过定量测量（双平面 Simpson 法）指导 EF 的确定。在教学干预 3 个月后，使用相同的方法向 25 名参与者展示了 14 例新病例。
使用 3 因素嵌套方差分析量化了教学干预前后的 IOV。这些因素是：观察者、患者、干预前后（时间）。方差分析表明，干预降低了 25 名读者在干预前后评估中的 IOV（F = 2.8，p = 0.007）。IOV 从干预前的±14%EF 降低到干预后的±8.4%EF（IOV 降低了 40%）。
在一个具有广泛培训水平和经验的大型超声心动图实验室中，简单的正式教学干预可以成功地减少 LVEF 评估的 IOV。这种干预不仅提供了离散的质量指标，还提供了一种实用的工具来记录和提高报告质量，从而可能减少临床效率低下和重复测试。
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