@article {M{\"u}ller-Brandes1347, author = {Christine M{\"u}ller-Brandes and Ursula Kr{\"a}mer and Monika Gappa and Gabriele Seitner-Sorge and Anke H{\"u}ls and Andrea von Berg and Barbara Hoffmann and Antje Schuster and Sabina Illi and Matthias Wisbauer and Dietrich Berdel}, title = {LUNOKID: can numerical American Thoracic Society/European Respiratory Society quality criteria replace visual inspection of spirometry?}, volume = {43}, number = {5}, pages = {1347--1356}, year = {2014}, doi = {10.1183/09031936.00058813}, publisher = {European Respiratory Society}, abstract = {The gold standard for assessing quality of forced expiratory manoeuvres is visual inspection by an expert. American Thoracic Society/European Respiratory Society numerical quality criteria (NQC) include back-extrapolated volume (BEV), repeatability and forced expiratory time (FET). Equipment currently available provides feedback tempting the investigator to use NQC as pass{\textendash}fail criterion. To investigate whether using NQC instead of visual acceptability is a valid option, we analysed data from a multicentre national reference study in Germany of children aged 4{\textendash}18 years. Spirometry was performed under field conditions. Receiver operating characteristic analysis was used to assess performance of BEV, repeatability, FET and a combination thereof in relation to visual acceptability. We included data from 3133 healthy Caucasians in the analyses; 72\% delivered at least two visually acceptable manoeuvres. Of these, 59\% would have been rejected based on combined NQC, mainly because the FET criterion was not feasible. Specificity of the NQC was generally low (BEV 10\%, repeatability 30\% and FET 50\%). Receiver operating characteristic analysis showed that a combination of the three measures could reach at best a sensitivity of 90\% and specificity of 56\%. We conclude that visual control is mandatory and NQC may help obtain the best possible results, but a fixed cut-off for FET should be abandoned. Visual control of spirometry is mandatory: quality criteria may help to get best results, but we should abandon FET http://ow.ly/uje5B}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/43/5/1347}, eprint = {https://erj.ersjournals.com/content/43/5/1347.full.pdf}, journal = {European Respiratory Journal} }