Influence of peer review medical audit on pathophysiological interpretation of nerve conduction studies in polyneuropathies.
OBJECTIVE
To evaluate the possible influence of peer review medical audit on experienced physicians' pathophysiological interpretation of nerve conduction studies in polyneuropathy patients.


METHODS
Since 1992, 7 European neurophysiologists have collected samples of their patient examinations for regular review where the physicians interpret each other's cases electronically and subsequently discuss them at regular workshop meetings (i.e. a form of medical audit). Two sets of 100 polyneuropathy examinations interpreted with an interval of 4-6 years were selected. The sets contained 1456 and 1719 nerve conduction studies, each given a pathophysiological test conclusion by each individual physician. Inter-physician agreement on interpretation of demyelination and axonal loss of the nerve, as well as neuropathic and unspecific findings, was estimated using kappa statistics.


RESULTS
Increased agreement from set 1 to set 2 was found on interpretation of demyelination of the nerve (set 1: kappa=0.22; set 2: kappa=0.45), and of neuropathic (set 1: kappa=0.46; set 2: kappa=0.64) and unspecific findings (set 1: kappa=0.35; set 2: kappa=0.54). No changes were found on interpretation of axonal loss (set 1: kappa=0.26; set 2: kappa=0.31) and normal findings (set 1 and set 2: kappa=0.90).


CONCLUSIONS
Participation in regular peer review medical audit resulted in increased agreement on interpretation of nerve conduction studies for 6 of the 7 participants. The study further highlights the need for better definition of criteria for identification of demyelinating, and in particular, axonal peripheral neuropathies.


CONCLUSIONS
International collaboration involving peer review medical audit may contribute to development of practice guidelines and, in turn, to increased quality of electrodiagnostic medicine.
Tankisi
Hatice
H
Department of Clinical Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, DK 8000 Aarhus C, Denmark.
Pugdahl
Kirsten
K
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 A
WA
Olsen
Mette L
ML
Schofield
Ian S
IS
D001369:Axons / Q000473:pathology; D003711:Demyelinating Diseases; D004568:Electrodiagnosis / Q000379:methods / Q000592:standards*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008485:Medical Audit; D009431:Neural Conduction / Q000502:physiology*; D010379:Peer Group; D010525:Peripheral Nerves / Q000503:physiopathology; D011115:Polyneuropathies / Q000175:diagnosis* / Q000503:physiopathology*