Can a Teaching Intervention Reduce Interobserver Variability in LVEF Assessment A Quality Control Exercise in the Echocardiography Lab
Can a Teaching Intervention Reduce Interobserver Variability in LVEF Assessment A Quality Control Exercise in the Echocardiography Lab
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DOI：
10.1016/j.jcmg.2011.06.004
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发表时间：
2011-08-01
影响因子：
14
通讯作者：
Hung, Judy
中科院分区：
文献类型：
--
作者：
Johri, Amer M.;Picard, Michael H.;Hung, Judy
目的：本研究旨在确定形式化的教学干预是否可以降低超声医师和具有丰富经验的医师在左室射血分数（LVEF）视觉估计中的观察者间变异性（IOV）。背景：准确可靠的超声心动图评估LVEF对于临床决策和减少重复检测是必要的。视觉估计LVEF的技巧因经验而异，对确证EF的量化至关重要。如果多个阅读者在连续考试中评估EF， IOV也可能导致不一致。方法14例二维超声心动图显示给25名参与者，他们根据左室壁运动的完整评估来估计EF，包括胸骨旁、短轴、根尖和肋下视图。这些病例代表了EF范围、图像质量和临床背景的频谱。在最初的解释之后，参与者进行了教学干预，包括参考案例的指导复习和每个案例的小组讨论，并在定量测量（双翼辛普森法）的指导下确定EF。教学干预三个月后，按照同样的方法，向25名参与者展示了14个新病例。结果采用三因素嵌套方差分析对教学干预前后的IOV进行量化。影响因素为：观察者、患者、干预前后（时间）。方差分析显示，干预降低了25名读者在干预前和干预后的IOV （F = 2.8, p = 0.007）。IOV从干预前的+/- 14% EF下降到干预后的+/- 8.4% EF （IOV降低了40%）。结论在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、形式化的教学干预可成功降低LVEF评估的IOV。这种干预不仅提供了离散的质量测量，而且还作为记录和提高报告质量的实用工具，潜在地减少了临床效率低下和重复测试。[J]中华医学会心脏科杂志，2011;4 (4):821- 921
OBJECTIVES 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.BACKGROUND 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.METHODS 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.RESULTS 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).CONCLUSIONS 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. (J Am Coll Cardiol Img 2011;4:821-9) (C) 2011 by the American College of Cardiology Foundation