A quality control exercise in the echo laboratory: Reduction in inter-observer variability in the interpretation of pulmonary hypertension
A quality control exercise in the echo laboratory: Reduction in inter-observer variability in the interpretation of pulmonary hypertension
复制标题
DOI：
10.1111/echo.13712
复制
发表时间：
2017-12-01
影响因子：
1.5
通讯作者：
Johri, Amer M.
中科院分区：
文献类型：
--
作者：
Patton, Daniel M.;Enzevaie, Atoosa;Johri, Amer M.
背景超声心动图估计的右心室收缩压（RVSP）对于肺动脉高压（PH）的初步筛查和随访至关重要。 RVSP 的观察者间变异性 (IOV) 会影响临床决策。本研究评估了简单的基于指南的教学干预是否可以降低 RVSP 解释中的 IOV。 方法和结果 高容量三级超声心动图实验室的 11 名参与者在一系列经胸超声心动图 (TTE) 的 RVSP 评估中接受了基线 IOV 评估，描绘了教学干预前后各 8 例不同程度的 PH。观察者间方差（均方根误差）从基线时的 26.0mmHg(2) (5.1mmHg) 降至教学后干预后的 5.8mmHg(2) (2.4mmHg) (P=.025)。相应的类间系数（ICC）从0.89增加到0.98。与图像采集和解释相关的几个因素被确定为 RVSP 中 IOV 的影响因素。结果是开发了一种实用工具来减轻这些因素。结论在大容量回波实验室中，简单的结构化教学干预成功地降低了 RVSP 测量中的 IOV。
BackgroundRight ventricular systolic pressure (RVSP) estimated by echocardiography is critical for the initial screening and follow-up of pulmonary hypertension (PH). Inter-observer variability (IOV) in RVSP can impact clinical decision making. This study assessed whether a simple guideline-based teaching intervention could reduce the IOV in RVSP interpretation.Methods and ResultsEleven participants in a high-volume tertiary level echocardiography laboratory underwent an assessment of the baseline IOV in the assessment of RVSP for a series of transthoracic echocardiograms (TTE), depicting various degrees of PH among 8 cases each before and after a teaching intervention. The inter-observer variance (root-mean-square error) decreased from 26.0mmHg(2) (5.1mmHg) at baseline to 5.8mmHg(2) (2.4mmHg) post-teaching intervention (P=.025). The corresponding inter-class coefficient (ICC) increased from 0.89 to 0.98. Several factors relating to image acquisition and interpretation were identified as contributing to IOV in RVSP. The outcome was the development of a practical tool to mitigate these factors.ConclusionsA simple structured teaching intervention successfully reduced IOV in the measurement of RVSP in a high-volume echo laboratory.