Rationale: Current diagnosis of chronic hypersensitivity pneumonitis (cHP) involves considering a combination of clinical, radiological, and pathological information in multidisciplinary team discussions. However, this approach is highly variable with poor agreement between centers. Objectives: We aimed to identify diagnostic criteria for cHP that reach consensus among international experts. Methods: A 3-round modified Delphi survey was conducted between April and August 2017. Forty-five experts in interstitial lung disease from 14 countries participated in the online survey. Diagnostic items included in round 1 were generated using expert interviews and literature review. During rounds 1 and 2, experts rated the importance of each diagnostic item on a 5-point Likert scale. The a priori threshold of consensus was ≥ 75% of experts rating a diagnostic item as very important or important. In the third round, experts graded the items that met consensus as important and provided their level of diagnostic confidence for a series of clinical scenarios. Measurements and main results: Consensus was achieved on 18 of the 40 diagnostic items. Among these, experts gave the highest level of importance to the identification of a causative antigen, time relation between exposure and disease, mosaic attenuation on chest imaging, and poorly formed non-necrotizing granulomas on pathology. In clinical scenarios, the diagnostic confidence of experts in cHP was heightened by the presence of these diagnostic items. Conclusion: This consensus-based approach for the diagnosis of cHP represents a first step towards the development of international guidelines for the diagnosis of cHP.
Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis: An International Modified Delphi Survey / Julie Morisset 1, Kerri A Johannson 2, Kirk D Jones 3, Paul J Wolters 4, Harold R Collard 5, Simon L F Walsh 6, Brett Ley 7, HP Delphi Collaborators: Katerina M Antoniou, Deborah Assayag, Juergen Behr, Francesco Bonella, Kevin K Brown, Bridget F Collins, Yvon Cormier, Tamera J Corte, Ulrich Costabel, Sonye K Danoff, Kaissa de Boer, Evans R Fernandez Perez, Kevin R Flaherty, Nicole S L Goh, Ian Glaspole, Mark G Jones, Yasuhiro Kondoh, Michael Kreuter, Yves Lacasse, Lisa H Lancaster, David J Lederer, Joyce S Lee, Toby M Maher, Fernando J Martinez, Keith C Meyer, Joshua J Mooney, Xavier Munoz Gall, Paul W Noble, Imre Noth, Justin M Oldham, Carlos Alberto de Castro Pereira, Venerino Poletti, Moises Selman, Paolo Spagnolo, Elisabetta Renzoni, Luca Richeldi, Christopher J Ryerson, Jay H. Ryu, Margaret L Salisbury, Mary E Strek, Sara Tomassetti, Dominique Valeyre, Carlo Vancheri, Marlies S Wijsenbeek, Wim Wuyts. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - ELETTRONICO. - 197:(2018), pp. 1036-1044. [10.1164/rccm.201710-1986OC]
Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis: An International Modified Delphi Survey
Venerino Poletti;Sara Tomassetti;
2018
Abstract
Rationale: Current diagnosis of chronic hypersensitivity pneumonitis (cHP) involves considering a combination of clinical, radiological, and pathological information in multidisciplinary team discussions. However, this approach is highly variable with poor agreement between centers. Objectives: We aimed to identify diagnostic criteria for cHP that reach consensus among international experts. Methods: A 3-round modified Delphi survey was conducted between April and August 2017. Forty-five experts in interstitial lung disease from 14 countries participated in the online survey. Diagnostic items included in round 1 were generated using expert interviews and literature review. During rounds 1 and 2, experts rated the importance of each diagnostic item on a 5-point Likert scale. The a priori threshold of consensus was ≥ 75% of experts rating a diagnostic item as very important or important. In the third round, experts graded the items that met consensus as important and provided their level of diagnostic confidence for a series of clinical scenarios. Measurements and main results: Consensus was achieved on 18 of the 40 diagnostic items. Among these, experts gave the highest level of importance to the identification of a causative antigen, time relation between exposure and disease, mosaic attenuation on chest imaging, and poorly formed non-necrotizing granulomas on pathology. In clinical scenarios, the diagnostic confidence of experts in cHP was heightened by the presence of these diagnostic items. Conclusion: This consensus-based approach for the diagnosis of cHP represents a first step towards the development of international guidelines for the diagnosis of cHP.
I documenti in FLORE sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
