A Tool to Facilitate Spirometry Quality Control Assessment Using 2019 Standards

Rationale: The 2019 ATS/ERS spirometry standards provide objective and subjective manoeuvre acceptability criteria. Subjective components may lead to discordance among expert reviewers. A tool using the 2019 criteria was developed to give reviewers a common approach to determine test acceptability and facilitate a decision consensus. Methods: The tool, which incorporates artificial intelligence quality assessment, applied the objective acceptability criteria and displayed key points (FEV1, end-expiration) on F-V and V-T graphs to aid reviewers in assessing contours and identifying anomalies. The tool evaluates and reports FEV1, FVC, BEV, plateau volume, expiratory time, rise time and inspired volume following EOFE (FIVC). Subjective assessments were: achievement of maximal flow and volume; occurrence of cough, glottis closure or any anomaly in 1st second of expiration; and glottis closure or early termination after 1 s of expiration. Reviewers complete a yes/no check box for each criterion. The tool calculates whether the manoeuvre is acceptable or usable. Results: Three reviewers used the tool to assess 150 tests. 50 were repeated to assess intra-rater reliability, (Kappa: 0.83, 0.86 and 0.80). All reviewers agreed on 63% of 100 unique tests (Kappa=0.5). Using the tool to develop reviewer consensus on each test, the individual agreement with the consensus was 88%, 94% and 70%. Conclusion: Despite using a set of strong objective criteria defined by the spirometry standards, intra- and inter-rater disagreement in assessing spirometry manoeuvre acceptability persists. The developed tool can be used as a powerful way to standardise assessment and reduce variability, and its additional benefits are being investigated