Validation of Consensus Panel Diagnosis in Dementia
Validation of Consensus Panel Diagnosis in Dementia
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DOI：
10.1001/archneurol.2010.301
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发表时间：
2010-12-01
影响因子：
--
通讯作者：
Zamrini, Edward Y.
中科院分区：
文献类型：
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作者：
Gabel, Matthew J.;Foster, Norman L.;Zamrini, Edward Y.
背景：痴呆的临床诊断在很大程度上取决于对患者症状的主观解释。在研究中，当无法获得明确的病理结果时，共识小组经常用于确定诊断。然而，对群体决策的研究表明，许多因素会对小组绩效产生不利影响。目的：确定提高共识小组诊断的条件。设计：比较神经病理学诊断与仅基于临床症状、仅基于氟脱氧葡萄糖f18正电子发射断层扫描图像和仅基于症状加图像的个体和共识小组诊断。背景：在一项关于氟脱氧葡萄糖f18正电子发射断层扫描诊断效用的试点研究中，专家和受训者个人和共识小组使用改进的德尔菲法进行审议。患者：病理证实的阿尔茨海默病或额颞叶痴呆患者45例。主要结果测量：统计测量诊断的准确性，一致性和信心的个人评分者和小组成员之前和之后的共识审议。结果：当临床信息引起不同判断时，由学员和专家组成的共识方案超过了个别专家诊断的准确性。在这些情况下，共识是3.5倍更有可能产生正面的变化，而不是负面的准确性和诊断确定性的个别小组成员。这条强制达成群体共识的规则至少与多数同意和一致同意规则一样准确。结论：采用改进的德尔菲协议，以达成共识的诊断是合理的替代病理信息。当小组成员的判断不同时，该方案提高了诊断的准确性和确定性，并且易于适应其他研究和临床环境，同时避免了群体决策的潜在陷阱。
Background: The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance.Objective: To determine conditions that improve consensus panel diagnosis.Design: Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based On clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images.Setting: Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxy-glucose F 18 positron emission tomography.Patients: Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia.Main Outcome Measures: Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations.Results: The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules.Conclusions: Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.