What are the "Westgard rules"?

For convenience, we adopt a short hand notation to abbreviate different decision criteria or
control rules, e.g., 12s to indicate 1 control measurement exceeding 2s control limits. We prefer to
use subscripts to indicate the control limits, but other texts and papers may use somewhat
different notation (e.g. 1:2s rather than 12s) Combinations of rules are generally indicated by using
a "slash" mark (/) between control rules, e.g. 13s/22s.
The individual rule are defined below. The "thumbnail" graphic next to a rule shows an example
of control results that violate that rule. You can click on a graphic to get a larger picture that more
clearly illustrates the application of each control rule.

13s refers to a control rule that is commonly used with a Levey-Jennings chart
when the control limits are set as the mean plus 3s and the mean minus 3s. A
run is rejected when a single control measurement exceeds the mean plus 3s
or the mean minus 3s control limit.

12srefers to the control rule that is commonly used with a Levey-Jennings

chart when the control limits are set as the mean plus/minus 2s. In the original
Westgard multirule QC procedure, this rule is used as a warning rule to trigger
careful inspection of the control data by the following rejection rules.

22s - reject when 2 consecutive control measurements exceed the same

mean plus 2s or the same mean minus 2s control limit.

R4s - reject when 1 control measurement in a group exceeds the mean plus
2s and another exceeds the mean minus 2s.

41s - reject when 4 consecutive control measurements exceed the same mean
plus 1s or the same mean minus 1s control limit.

10x - reject when 10 consecutive control measurements fall on one side of

the mean.

In addition, you will sometimes see some modifications of this last rule to
make it fit more easily with Ns of 4:

8x - reject when 8 consecutive control measurements fall on one side of the

mean.

12x - reject when 12 consecutive control measurements fall on one side of

the mean.

The preceding control rules are usually used with N's of 2or 4, which means they are appropriate
when two different control materials are measured 1 or 2 times per material.

What are other common multirules?

In situations where 3 different control materials are being analyzed, some other control rules fit
better and are easier to apply, such as:

2of32s - reject when 2 out of 3 control measurements exceed the same mean plus 2s or mean minus
2s control limit;

31s - reject when 3 consecutive control measurements exceed the same mean plus 1s or mean minus
1s control limit.

6x - reject when 6 consecutive control measurements fall on one side of the mean.

In addition, you will sometimes see some modification of this last rule to include a larger number of
control measurements that still fit with an N of 3:

9x - reject when 9 consecutive control measurements fall on one side of the mean.

A related control rule that is sometimes used, particularly in Europe, looks for a "trend" where
several control measurements in a row are increasing or decreasing [note: it is increasingly rare to
see this rule in use]:

7T - reject when seven control measurements trend in the same direction, i.e., get progressively
higher or progressively lower.