M. Griffin et al., Field-by-field evaluation of intraoperative transoesophageal echocardiography interpretative skills, PHYSL MEAS, 21(1), 2000, pp. 165-173
Citations number
26
Categorie Soggetti
Research/Laboratory Medicine & Medical Tecnology",Physiology
A quality assurance system is essential for the credibility and structured
growth of anaesthesiology-based transoesophageal echocardiography (TEE) pro
grammes. We have developed software (Q/A Kappa), involving a 400-line sourc
e code, capable of directly reporting kappa correlation coefficient values,
using external reviewer interpretations as the 'gold standard', and thereb
y allowing systematic assessment of the validity of intraoperative echocard
iographic interpretation. This paper presents assessment of the validity of
240 intraoperative anaesthesiologists' echocardiographic interpretations,
and, in addition, the results of field testing of this prototypical softwar
e.
Data, derived from consecutive cardiac surgery patients, consisted of stand
ardized two-dimensional transoesophageal echocardiographic, colour flow and
Doppler imaging sequences. Intraoperative and off-line 'gold standard' TEE
interpretations were compared for 19 fields or variables using the Q/A Kap
pa program.
The kappa correlation coefficients were highly variable and dependent on th
e examination field, ranging from 0.08 for apical regional wall motion scor
es to 1.00 for tricuspid regurgitation grade, left atrial measurement, aort
ic valve anatomy and left ventricular long axis and short axis global funct
ion. The correlation coefficients were also operator dependent. These data
(480 interpretations) were also manually integrated into the equation requi
red for calculation of values of the variable kappa correlation coefficient
, The relationship between Q/A Kappa-derived values and manually calculated
values was highly significant (p < 0.001; r = 1.0).
The implications and possible explanations of the results for particular ex
amination fields are discussed. This study also demonstrates successful sea
mless functioning of this software program from data entry, segmentation in
to tables and valid statistical analysis, These findings suggest that it is
practical to provide sophisticated continuous quality improvement TEE data
on a routine basis.