Proficiency testing of skin prick testers as part of a quality assurance system

TY - JOUR

T1 - Proficiency testing of skin prick testers as part of a quality assurance system

AU - Malling, Hans-Jørgen

AU - Allesen-Holm, Pernille

AU - Karved, Lisbeth Sys

AU - Poulsen, Lars K

PY - 2016/9/21

Y1 - 2016/9/21

N2 - BACKGROUND: Skin prick test is an important diagnostic procedure in clinical allergy but documentation of the quality is often missing.METHODS: We describe a proficiency system to evaluate staff members in relation to the international recommended reproducibility in terms of coefficient of variation (CV < 40 %) and the linearity (coefficient of regression >0.85) based on blinded octuplicate histamine testing using histamine 3, 10, 30 and 100 mg/ml.RESULTS: Fourteen trained allergy nurses participated in the proficiency testing. More than 95 % of the nurses, generated coefficient of variation less than 40 %, and for around 35 % of testers the CV were below 20 % based on wheal area. Regarding the linearity (coefficient of regression), only two nurses produced tests with a value below 0.85. On the contrary, 79 % of testers demonstrated a coefficient of regression >0.95. Depending on the gentleness of the prick procedure, the inter-nurse variability in wheal area varied more than twofold corresponding to a 10-doubling of histamine concentration. This would never have been detected without using a proficiency testing system.CONCLUSION: The described histamine testing provides an objective system for the evaluation of basic skin test quality assessment standards especially for documentation in scientific studies.

AB - BACKGROUND: Skin prick test is an important diagnostic procedure in clinical allergy but documentation of the quality is often missing.METHODS: We describe a proficiency system to evaluate staff members in relation to the international recommended reproducibility in terms of coefficient of variation (CV < 40 %) and the linearity (coefficient of regression >0.85) based on blinded octuplicate histamine testing using histamine 3, 10, 30 and 100 mg/ml.RESULTS: Fourteen trained allergy nurses participated in the proficiency testing. More than 95 % of the nurses, generated coefficient of variation less than 40 %, and for around 35 % of testers the CV were below 20 % based on wheal area. Regarding the linearity (coefficient of regression), only two nurses produced tests with a value below 0.85. On the contrary, 79 % of testers demonstrated a coefficient of regression >0.95. Depending on the gentleness of the prick procedure, the inter-nurse variability in wheal area varied more than twofold corresponding to a 10-doubling of histamine concentration. This would never have been detected without using a proficiency testing system.CONCLUSION: The described histamine testing provides an objective system for the evaluation of basic skin test quality assessment standards especially for documentation in scientific studies.

KW - Journal Article

U2 - 10.1186/s13601-016-0126-7

DO - 10.1186/s13601-016-0126-7

M3 - Journal article

C2 - 27688875

SN - 2045-7022

VL - 6

JO - Clinical and Translational Allergy

JF - Clinical and Translational Allergy

M1 - 36

ER -