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 physiciansʹ electrodiagnostic criteria for polyneuropathy (PNP) diagnosing and classification. Methods Two sets of each physicianʹs 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 physiciansʹ clinical routine, possibly as they have accustomed themselves to apply criteria more strictly. Significance This study support that international collaboration is a useful step towards improvements in electrodiagnostic medicine.