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

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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.
Original languageEnglish
Article number190
JournalBMC Neurology
Volume14
DOIs
Publication statusPublished - 1 Jan 2014

Cite this

@article{28f09c3895fc4bc3a9106c44cd7ac17a,
title = "Optimizing the use of expert panel reference diagnoses in diagnostic studies of multidimensional syndromes",
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.",
author = "C.A.G. Wolfs and P. Aalten and P.M.M. Bossuyt and M.A. Joore and A.F.G. Leentjens and J.L. Severens and F.R.J. Verhey",
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language = "English",
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journal = "BMC Neurology",
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Optimizing the use of expert panel reference diagnoses in diagnostic studies of multidimensional syndromes. / Wolfs, C.A.G.; Aalten, P.; Bossuyt, P.M.M.; Joore, M.A.; Leentjens, A.F.G.; Severens, J.L.; Verhey, F.R.J.

In: BMC Neurology, Vol. 14, 190, 01.01.2014.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Optimizing the use of expert panel reference diagnoses in diagnostic studies of multidimensional syndromes

AU - Wolfs, C.A.G.

AU - Aalten, P.

AU - Bossuyt, P.M.M.

AU - Joore, M.A.

AU - Leentjens, A.F.G.

AU - Severens, J.L.

AU - Verhey, F.R.J.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

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