Daubert Melissa A, Yow Eric, Barnhart Huiman X, Rabineau Dawn, Crowley Anna Lisa, Douglas Pamela S
Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
J Am Soc Echocardiogr. 2015 Aug;28(8):959-68. doi: 10.1016/j.echo.2015.03.004. Epub 2015 Apr 11.
Interpretative variability can adversely affect echocardiographic reliability, but there is no widely accepted method to minimize variability and improve reproducibility.
A continuous quality improvement process was devised that involves testing reproducibility by assessment of measurement differences followed by robust review, retraining, and retesting. Reproducibility was deemed acceptable if ≥80% of all interreader comparisons were within a prespecified acceptable difference. Readers not meeting this standard underwent retraining and retesting until acceptable reproducibility was achieved for the following parameters: left ventricular end-diastolic volume, biplane ejection fraction, mitral and aortic regurgitation, left ventricular outflow tract diameter, peak and mean aortic valve gradients, and aortic valve area. Eight hundred interreader comparisons for evaluation of reproducibility were generated from five readers interpreting 10 echocardiograms per testing cycle. The applicability and efficacy of this method were then evaluated by testing a second larger group of 10 readers and reevaluating reproducibility 1 year later.
All readers demonstrated acceptable reproducibility for biplane ejection fraction, mitral regurgitation, and peak and mean aortic valve gradients. Acceptable reproducibility for left ventricular end-diastolic volume, aortic regurgitation, and aortic valve area was achieved by four of five readers. No readers attained acceptable reproducibility on initial evaluation of left ventricular outflow tract diameter. After review and retraining, all readers demonstrated acceptable reproducibility, which was maintained on subsequent testing 1 year later. A second larger group of 10 readers was also evaluated and yielded similar results.
A continuous quality improvement process was devised that successfully reduced interpretative variability in echocardiography and improved reproducibility that was sustained over time.
解读的变异性会对超声心动图的可靠性产生不利影响，但目前尚无被广泛接受的方法来最小化变异性并提高可重复性。
设计了一个持续质量改进流程，该流程通过评估测量差异来测试可重复性，随后进行严格审查、再培训和重新测试。如果所有读者间比较中≥80%的数据在预先设定的可接受差异范围内，则认为可重复性是可接受的。未达到该标准的读者需接受再培训和重新测试，直至在以下参数方面达到可接受的可重复性：左心室舒张末期容积、双平面射血分数、二尖瓣和主动脉瓣反流、左心室流出道直径、主动脉瓣峰值和平均梯度以及主动脉瓣面积。在每个测试周期中，由5名读者解读10份超声心动图，共产生800次读者间比较以评估可重复性。然后通过测试另一组规模更大的10名读者并在1年后重新评估可重复性，来评估该方法的适用性和有效性。
所有读者在双平面射血分数、二尖瓣反流以及主动脉瓣峰值和平均梯度方面均表现出可接受的可重复性。5名读者中有4名在左心室舒张末期容积、主动脉瓣反流和主动脉瓣面积方面达到了可接受的可重复性。在对左心室流出道直径进行初始评估时，没有读者达到可接受的可重复性。经过审查和再培训后，所有读者均表现出可接受的可重复性，且在1年后的后续测试中得以维持。另一组规模更大的10名读者也接受了评估，结果相似。
设计了一个持续质量改进流程，该流程成功降低了超声心动图解读的变异性，并提高了随时间持续保持的可重复性。
