Expert panel diagnosis demonstrated high reproducibility as reference standard in infectious diseases
van Houten, Chantal B.; Naaktgeboren, Christiana A.; Ashkenazi-Hoffnung, Liat; Ashkenazi, Shai; Avis, Wim; Chistyakov, Irena; Corigliano, Teresa; Galetto, Annick; Gangoiti, Iker; Gervaix, Alain; Glikman, Daniel; Ivaskeviciene, Inga; Kuperman, Amir A.; Lacroix, Laurence; Loeffen, Yvette; Luterbacher, Fanny; Meijssen, Clemens B.; Mintegi, Santiago; Nasrallah, Basheer; Papan, Cihan; van Rossum, Annemarie M.C.; Rudolph, Henriette; Stein, Michal; Tal, Roie; Tenenbaum, Tobias; Usonis, Vytautas; de Waal, Wouter; Weichert, Stefan; Wildenbeest, Joanne G.; de Winter-de Groot, Karin M.; Wolfs, Tom F.W.; Mastboim, Niv; Gottlieb, Tanya M.; Cohen, Asi; Oved, Kfir; Eden, Eran; Feigin, Paul D.; Shani, Liran; Bont, Louis J.; the IMPRIND consortium
(2019) Journal of Clinical Epidemiology, volume 112, pp. 20 - 27
(Article)
Abstract
Objective: If a gold standard is lacking in a diagnostic test accuracy study, expert diagnosis is frequently used as reference standard. However, interobserver and intraobserver agreements are imperfect. The aim of this study was to quantify the reproducibility of a panel diagnosis for pediatric infectious diseases. Study Design and Setting:
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Pediatricians from six countries adjudicated a diagnosis (i.e., bacterial infection, viral infection, or indeterminate)for febrile children. Diagnosis was reached when the majority of panel members came to the same diagnosis, leaving others inconclusive. We evaluated intraobserver and intrapanel agreement with 6 weeks and 3 years’ time intervals. We calculated the proportion of inconclusive diagnosis for a three-, five-, and seven-expert panel. Results: For both time intervals (i.e., 6 weeks and 3 years), intrapanel agreement was higher (kappa 0.88, 95%CI: 0.81-0.94 and 0.80, 95%CI: NA)compared to intraobserver agreement (kappa 0.77, 95%CI: 0.71-0.83 and 0.65, 95%CI: 0.52-0.78). After expanding the three-expert panel to five or seven experts, the proportion of inconclusive diagnoses (11%)remained the same. Conclusion: A panel consisting of three experts provides more reproducible diagnoses than an individual expert in children with lower respiratory tract infection or fever without source. Increasing the size of a panel beyond three experts has no major advantage for diagnosis reproducibility.
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Keywords: Diagnosis, Expert panel, Gold standard, Infectious diseases, Reference standard, Reproducibility, Epidemiology
ISSN: 0895-4356
Publisher: Elsevier USA
Note: Funding Information: Funding: The first author (C.H.)was funded by the TAILORED-Treatment study, which received funding from the EU's Seventh Framework Program FP7 under REA grant agreement No. HEALTH-F3–602860-2013 (TAILORED-Treatment; www.tailored-treatment.eu/). Publisher Copyright: © 2019 Elsevier Inc. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
(Peer reviewed)