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Optimizing the use of expert panel reference diagnoses in diagnostic studies of multidimensional syndromes.

Handels RL, Wolfs CA, Aalten P, Bossuyt PM, Joore MA, Leentjens AF, Severens JL, Verhey FR - BMC Neurol (2014)

Bottom Line: This did not increase after the consensus discussion meeting.The process evaluation led to several recommendations for improvement of the protocol.A protocol for attaining a reference diagnosis based on expert panel consensus was shown feasible in research practice.

View Article: PubMed Central - PubMed

ABSTRACT

Background: In the absence of a gold standard, a panel of experts can be invited to assign a reference diagnosis for use in research. Available literature offers limited guidance on assembling and working with an expert panel for this purpose. We aimed to develop a protocol for an expert panel consensus diagnosis and evaluated its applicability in a pilot project.

Methods: An adjusted Delphi method was used, which started with the assessment of clinical vignettes by 3 experts individually, followed by a consensus discussion meeting to solve diagnostic discrepancies. A panel facilitator ensured that all experts were able to express their views, and encouraged the use of argumentation to arrive at a specific diagnosis, until consensus was reached by all experts. Eleven vignettes of patients suspected of having a primary neurodegenerative disease were presented to the experts. Clinical information was provided stepwise and included medical history, neurological, physical and cognitive function, brain MRI scan, and follow-up assessments over 2 years. After the consensus discussion meeting, the procedure was evaluated by the experts.

Results: The average degree of consensus for the reference diagnosis increased from 52% after individual assessment of the vignettes to 94% after the consensus discussion meeting. Average confidence in the diagnosis after individual assessment was 85%. This did not increase after the consensus discussion meeting. The process evaluation led to several recommendations for improvement of the protocol.

Conclusion: A protocol for attaining a reference diagnosis based on expert panel consensus was shown feasible in research practice.

No MeSH data available.


Related in: MedlinePlus

Process flow of the consensus protocol.Abbreviations: FU, follow-up.
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Fig1: Process flow of the consensus protocol.Abbreviations: FU, follow-up.

Mentions: Two diagnoses were set: a care-as-usual diagnosis (reflecting a first visit to a memory clinic) and a reference diagnosis (the best available way to arrive at a clinical classification). For both diagnoses an adjusted Delphi method was applied that started with the assessment of each case by each expert individually, followed by determining diagnostic discrepancies. The discrepancies were then discussed in a consensus meeting between the experts to resolve the discrepancies. This 3-step approach is graphically presented in FigureĀ 1 and explained below.Figure 1


Optimizing the use of expert panel reference diagnoses in diagnostic studies of multidimensional syndromes.

Handels RL, Wolfs CA, Aalten P, Bossuyt PM, Joore MA, Leentjens AF, Severens JL, Verhey FR - BMC Neurol (2014)

Process flow of the consensus protocol.Abbreviations: FU, follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195860&req=5

Fig1: Process flow of the consensus protocol.Abbreviations: FU, follow-up.
Mentions: Two diagnoses were set: a care-as-usual diagnosis (reflecting a first visit to a memory clinic) and a reference diagnosis (the best available way to arrive at a clinical classification). For both diagnoses an adjusted Delphi method was applied that started with the assessment of each case by each expert individually, followed by determining diagnostic discrepancies. The discrepancies were then discussed in a consensus meeting between the experts to resolve the discrepancies. This 3-step approach is graphically presented in FigureĀ 1 and explained below.Figure 1

Bottom Line: This did not increase after the consensus discussion meeting.The process evaluation led to several recommendations for improvement of the protocol.A protocol for attaining a reference diagnosis based on expert panel consensus was shown feasible in research practice.

View Article: PubMed Central - PubMed

ABSTRACT

Background: In the absence of a gold standard, a panel of experts can be invited to assign a reference diagnosis for use in research. Available literature offers limited guidance on assembling and working with an expert panel for this purpose. We aimed to develop a protocol for an expert panel consensus diagnosis and evaluated its applicability in a pilot project.

Methods: An adjusted Delphi method was used, which started with the assessment of clinical vignettes by 3 experts individually, followed by a consensus discussion meeting to solve diagnostic discrepancies. A panel facilitator ensured that all experts were able to express their views, and encouraged the use of argumentation to arrive at a specific diagnosis, until consensus was reached by all experts. Eleven vignettes of patients suspected of having a primary neurodegenerative disease were presented to the experts. Clinical information was provided stepwise and included medical history, neurological, physical and cognitive function, brain MRI scan, and follow-up assessments over 2 years. After the consensus discussion meeting, the procedure was evaluated by the experts.

Results: The average degree of consensus for the reference diagnosis increased from 52% after individual assessment of the vignettes to 94% after the consensus discussion meeting. Average confidence in the diagnosis after individual assessment was 85%. This did not increase after the consensus discussion meeting. The process evaluation led to several recommendations for improvement of the protocol.

Conclusion: A protocol for attaining a reference diagnosis based on expert panel consensus was shown feasible in research practice.

No MeSH data available.


Related in: MedlinePlus