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: κ=0.22; set 2: κ=0.45), and of neuropathic (set 1: κ=0.46; set 2: κ=0.64) and unspecific findings (set 1: κ=0.35; set 2: κ=0.54). No changes were found on interpretation of axonal loss (set 1: κ=0.26; set 2: κ=0.31) and normal findings (set 1 and set 2: κ=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. Significance: International collaboration involving peer review medical audit may contribute to development of practice guidelines and, in turn, to increased quality of electrodiagnostic medicine.