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Quality control of synovial fluid crystal identification
a Rheumatism Foundation Hospital, Heinola, Finland, b Labquality,
Helsinki, Finland
Correspondence to: Dr R Pikkarainen, Labquality, Ratamestarinkatu 11, FIN-00520 Helsinki, Finland.
Accepted for publication 13 November 1997
OBJECTIVE
To establish a quality assessment
programme for the diagnosis of crystal arthropathies by synovial fluid
(SF) microscopy.
METHODSThree or four cytocentrifuge slides
prepared from suitable patient SF specimens were distributed to 25-47
predominantly Finnish clinical laboratories once a year. Sodium urate
crystals were included in every survey.
RESULTSReturns for the years 1989-1996 were
reviewed. Laboratories that participated in > four surveys made on an
average one error a year (range 0.25-2). The error rate for specimens
containing abundant crystals was acceptable but it increased
considerably for specimens showing few crystals per microscope field.
No laboratory characteristic predictive of successful performance was found.
CONCLUSIONErrors in quality assessment results
for crystal identification were much more frequent than in the fields
of, for example, clinical chemistry or microbiology. Despite efforts to
provide educational feedback, no improvement was seen during the study period. Because of the dearth of data from other parts of the world it
is not known for certain whether this study has merely pinpointed a
local problem or if the same trend applies elsewhere.
© 1998 by Annals of the Rheumatic Diseases
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