Epidemiologic approach to quality assessment in echocardiographic diagnosis

Alan K. Berger, Mary Anne Yohe, Gary A. Chase, Neil J. Weissman, Brace K. Lloyd, John S. Gottdiener

Research output: Contribution to journalArticlepeer-review


In industry, measurement of product uniformity is a key component of quality control (QC). In echocardiography QC has usually focused on review of small numbers of cases or determination of reader variability in selected subsets. If in a large sample, patient characteristics are distributed equally among readers, diagnostic biases in clinical practice might be discerned utilizing large computerized databases to determine interreader differences in diagnostic prevalence. Hence, 6026 echocardiograms in a computerized database read by one of three level 3 (ASE) readers were tested for frequency (%) differences among four coded diagnostic statements (RWMA-regional wall motion abnormality): Reader, n #1 (2702) #2 (2101) #3 (1223) P (ANOVA) Mitral Prolapse 5.3 3.0 4.8 .0005 Vegetation 0.7 0.3 0.2 .07 LV Thrombus 1.9 0.4 0.5 .0001 RWMA 14.1 12.1 10.7 .007 There were no significant interreader differences between pt age, gender, or proportion of pts with severe LV dysfunction (EF ≤ 35%). Conclusion: Substantial interreader differences may exist in clinical practice. Assuming absence of assignment bias, computerized databases facilitate ongoing monitoring of interreader bias despite low diagnostic prevalence. This may avoid the necessity for large prospective analyses of reader variability, and target opportunities for subsequent quality improvement.

Original languageEnglish (US)
Pages (from-to)401
Number of pages1
JournalJournal of the American Society of Echocardiography
Issue number4
StatePublished - 1997


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