The relationship of intralaboratory bias and imprecision on laboratories' ability to meet medical usefulness limits.

The previously described computer modeling technic empirically develops quantitative relationships between intralaboratory performance, as characterized by individual laboratories' coefficients of variation (CVs) and biases, and clinical "medical usefulness limits." These limits determine the magnitude of total analytic error, the combined effects of CV and bias that can be tolerated by the clinician. The computer model delineates all combinations of CV and bias compatible with specified medical usefulness limits. Both CV and bias are critical in determining a laboratory's ability to meet medical usefulness limits. For example, a laboratory with a 6% CV and zero bias will meet the +/- 10% or less total analytic error (medical usefulness limit) 90% of the time. If the medical usefulness limit is expanded to +/- 15%, a laboratory with a 6% CV can tolerate coexisting relative biases of up to 4% and still meet this limit 95% of the time. Plots of the limiting values for combinations of intralaboratory CV and bias are given that allow the laboratory's results to fall within medical usefulness limits of 2, 5, 10, 15, and 20%.