Influence of medical audit on electrodiagnostic evaluation of polyneuropathy. A multicentre study.
OBJECTIVE
Since 1992, 7 European neurophysiologists have participated in the ESTEEM project concerned with improvements in electrodiagnostic medicine. This study assesses whether the collaboration that includes peer review medical audit has influenced the involved physicians' electrodiagnostic criteria for polyneuropathy (PNP) diagnosing and classification.


METHODS
Two sets of each physician's PNP examinations performed early and late in the study were examined for changes in (1) number of studies with abnormal electrophysiological findings required for diagnosing PNP, and (2) agreement between the classifications given by the individual physicians and the peer review group.


RESULTS
The average number of abnormal motor nerve segments per patient increased from 4.6 to 6.4 during the study. Although most individual changes were minor, the second set of examinations showed an increased homogeneity among the physicians in the number of abnormal motor nerve segments and abnormal F wave studies, and a tendency towards increased homogeneity in the number of abnormal sensory nerve segments. There was also an increased agreement on pathophysiological PNP classification in the second set of examinations compared to the first set.


CONCLUSIONS
The participation in the ESTEEM project seems to have impacted the physicians' clinical routine, possibly as they have accustomed themselves to apply criteria more strictly.


CONCLUSIONS
This study support that international collaboration is a useful step towards improvements in electrodiagnostic medicine.
Pugdahl
Kirsten
K
Department of Clinical Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, Building 10, 8000 Aarhus C, Denmark.
Tankisi
Hatice
H
Fuglsang-Frederiksen
Anders
A
Johnsen
Birger
B
de Carvalho
Mamede
M
Fawcett
Peter R W
PR
Labarre-Vila
Annick
A
Liguori
Rocco
R
Nix
Wilfred
W
Olsen
Mette L
ML
Schofield
Ian S
IS
D000704:Analysis of Variance; D032921:Consensus; D004568:Electrodiagnosis / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008485:Medical Audit / Q000379:methods / Q000706:statistics & numerical data*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009431:Neural Conduction / Q000502:physiology; D011115:Polyneuropathies / Q000175:diagnosis*