Evaluation of the average of patients: application to endocrine assays

Recent work (Cembrowski et al, Am J Clin Pathol 1984;81:492-499) has shown that the average of selected patient data can theoretically be used to demonstrate systematic errors. We formerly demonstrate that the sensitivity or power of the 'average of patients' (AOP) is related to the index (NpSw2)/Sp2 where Np is the number of patient results averaged, Sw the within-run component of the standard deviation of the analytical method and Sp the standard deviation of the trimmed population. The utility of the AOP can therefore be assessed rapidly without power function curves or the calculation of the daily AOP itself. The index showed that, for 12 radioimmunoassays done in our laboratory, the power of the AOP was greatest for T3 uptake, then FTI, then T4. Daily AOP were followed for these tests with control results on parallel Shewhart plots. We also applied an exponential smoothing procedure on the AOP and control results to improve trend detection. These analyses demonstrated that the AOP can improve the detection of systematic errors and the differentiation of true errors from errors affecting only control specimens.