The Cicchetti–Allison weighting matrix is positive definite

Internal quality assurance in diagnostic microbiology: A simple approach for insightful data

Given the importance of microbiology results on patient care, high quality standards are expected. Internal quality assurance (IQA) could mitigate the limitations of internal quality control, competency assessment and external quality assurance, adding a longitudinal insight, including pre- and post-analytical steps. Here, we implemented an IQA program in our clinical microbiology facilities with blind resubmission of routine samples during 22 months. One-hundred-and-twenty-one out of 123 (98.4%) serological analyses and 112 out of 122 (91.8%) molecular analyses were concordant. Among the discordances in molecular biology analyses, 6 results were low positive samples that turned out negative, likely due to stochastic repartition of nucleic acids. Moreover, one identified retranscription error led us to implement automated results transmission from the Applied Biosystems instruments to the laboratory information system (LIS). Regarding Gram stain microscopy, 560 out of 745 (75.2%) of compared parameters were concordant. As many as 67 out of 84 (79.8%) pairs of culture results were similar, including 16 sterile pairs, 27 having identical identification or description and semi-quantification and 24 only showing variations in semi-quantification with identical description or identification of colonies. Seventeen pairs had diverging identification or description of colonies. Culture was twice only done for one member of the pairs. Regarding antibiotic susceptibility testing, a major discrepancy was observed in 5 out of 48 results (10.4%). In conclusion, serological tests were highly reproducible. Molecular diagnosis also revealed to be robust except when the amounts of nucleic acids present in the sample were close to the limits of detection. Conventional microbiology was less robust with major discrepancies reaching 39.5% of the samples for microscopy. Similarly, culture and antibiotic susceptibility testing were prone to discrepancies. This work was ground for reconsidering multiples aspects of our practices and demonstrates the importance of IQA to complete the other quality management procedures.

A Note on the Linearly and Quadratically Weighted Kappa Coefficients

The linearly and quadratically weighted kappa coefficients are popular statistics in measuring inter-rater agreement on an ordinal scale. It has been recently demonstrated that the linearly weighted kappa is a weighted average of the kappa coefficients of the embedded 2 by 2 agreement matrices, while the quadratically weighted kappa is insensitive to the agreement matrices that are row or column reflection symmetric. A rank-one matrix decomposition approach to the weighting schemes is presented in this note such that these phenomena can be demonstrated in a concise manner.

A New Interpretation of the Weighted Kappa Coefficients

Reliability and agreement studies are of paramount importance. They do contribute to the quality of studies by providing information about the amount of error inherent to any diagnosis, score or measurement. Guidelines for reporting reliability and agreement studies were recently provided. While the use of the kappa-like family is advised for categorical and ordinal scales, no further guideline in the choice of a weighting scheme is given. In the present paper, a new simple and practical interpretation of the linear- and quadratic-weighted kappa coefficients is given. This will help researchers in motivating their choice of a weighting scheme.