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.

Additional Metadata
Keywords Reference diagnosis, Consensus panel, Delphi, Gold standard, Diagnostic validation, Incorporation bias, Multidimensional syndromes, Alzheimer’s disease
Persistent URL dx.doi.org/10.1186/s12883-014-0190-3, hdl.handle.net/1765/77127
Journal BMC Neurology
Citation
Handels, R.L, Wolfs, C.A.G, Aalten, P, Bossuyt, P.M.M, Joore, M.A, Leentjens, A.F. G, … Verhey, F.R.J. (2014). Optimizing the use of expert panel reference diagnoses in diagnostic studies of multidimensional syndromes. BMC Neurology, 14(1), 1–9. doi:10.1186/s12883-014-0190-3