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Leishmaniasis direct agglutination test : using pictorials as training materials to reduce inter-reader variability and improve accuracy
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Adams, Emily R., Jacquet, Diane, Schoone, Gerard, Gidwani, Kamlesh, Boelaert, Marleen and Cunningham, Jane (2012) Leishmaniasis direct agglutination test : using pictorials as training materials to reduce inter-reader variability and improve accuracy. PLoS Neglected Tropical Diseases, 6 (12). e1946. doi:10.1371/journal.pntd.0001946 ISSN 1935-2735.
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Official URL: http://dx.doi.org/10.1371/journal.pntd.0001946
Abstract
Background:
The Direct Agglutination Test (DAT) has a high diagnostic accuracy and remains, in some geographical areas, part of the diagnostic algorithm for Visceral Leishmaniasis (VL). However, subjective interpretation of results introduces potential for inter-reader variation. We report an assessment of inter-laboratory agreement and propose a pictorial-based approach to standardize reading of the DAT.
Methodology:
In preparation for a comparative evaluation of immunochromatographic diagnostics for VL, a proficiency panel of 15 well-characterized sera, DAT-antigen from a single batch and common protocol was sent to nine laboratories in Latin-America, East-Africa and Asia. Agreement (i.e., equal titre or within 1 titer) with the reading by the reference laboratory was computed. Due to significant inter-laboratory disagreement on-site refresher training was provided to all technicians performing DAT. Photos of training plates were made, and end-titres agreed upon by experienced users of DAT within the Visceral-Leishmaniasis Laboratory-Network (VL-LN).
Results:
Pre-training, concordance in DAT results with reference laboratories was only 50%, although agreement on negative sera was high (94%). After refresher training concordance increased to 84%; agreement on negative controls increased to 98%. Variance in readings significantly decreased after training from 3.3 titres to an average of 1.0 titre (two-sample Wilcoxon rank-sum (Mann-Whitney) test (z = −3,624 and p = 0.0003)).
Conclusion:
The most probable explanation for disagreement was subjective endpoint reading. Using pictorials as training materials may be a useful tool to reduce disparity in results and promote more standardized reading of DAT, without compromising diagnostic sensitivity.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine | ||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Leishmaniasis, Agglutination tests | ||||
| Journal or Publication Title: | PLoS Neglected Tropical Diseases | ||||
| Publisher: | Public Library of Science | ||||
| ISSN: | 1935-2735 | ||||
| Official Date: | 13 December 2012 | ||||
| Dates: |
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| Volume: | 6 | ||||
| Number: | 12 | ||||
| Number of Pages: | 6 | ||||
| Article Number: | e1946 | ||||
| DOI: | 10.1371/journal.pntd.0001946 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||
| Date of first compliant deposit: | 22 July 2016 | ||||
| Date of first compliant Open Access: | 22 July 2016 |
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