Validation of consensus panel diagnosis in dementia

Matthew J. Gabel, Norman L. Foster, Judith L. Heidebrink, Roger Higdon, Howard J. Aizenstein, Steven E. Arnold, Nancy R. Barbas, Bradley F. Boeve, James R. Burke, Christopher M. Clark, Steven T. DeKosky, Martin R. Farlow, William J. Jagust, Claudia H. Kawas, Robert A. Koeppe, James B. Leverenz, Anne M. Lipton, Elaine R. Peskind, R. Scott Turner, Kyle B. Womack & 1 others Edward Y. Zamrini

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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 fludeoxyglucose 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.

Original languageEnglish (US)
Pages (from-to)1506-1512
Number of pages7
JournalArchives of Neurology
Volume67
Issue number12
DOIs
StatePublished - Dec 2010

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Dementia
Consensus
Fluorodeoxyglucose F18
Research
Positron-Emission Tomography
Decision Making
Alzheimer Disease
Frontotemporal Dementia
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Gabel, M. J., Foster, N. L., Heidebrink, J. L., Higdon, R., Aizenstein, H. J., Arnold, S. E., ... Zamrini, E. Y. (2010). Validation of consensus panel diagnosis in dementia. Archives of Neurology, 67(12), 1506-1512. https://doi.org/10.1001/archneurol.2010.301

Validation of consensus panel diagnosis in dementia. / Gabel, Matthew J.; Foster, Norman L.; Heidebrink, Judith L.; Higdon, Roger; Aizenstein, Howard J.; Arnold, Steven E.; Barbas, Nancy R.; Boeve, Bradley F.; Burke, James R.; Clark, Christopher M.; DeKosky, Steven T.; Farlow, Martin R.; Jagust, William J.; Kawas, Claudia H.; Koeppe, Robert A.; Leverenz, James B.; Lipton, Anne M.; Peskind, Elaine R.; Turner, R. Scott; Womack, Kyle B.; Zamrini, Edward Y.

In: Archives of Neurology, Vol. 67, No. 12, 12.2010, p. 1506-1512.

Research output: Contribution to journalArticle

Gabel, MJ, Foster, NL, Heidebrink, JL, Higdon, R, Aizenstein, HJ, Arnold, SE, Barbas, NR, Boeve, BF, Burke, JR, Clark, CM, DeKosky, ST, Farlow, MR, Jagust, WJ, Kawas, CH, Koeppe, RA, Leverenz, JB, Lipton, AM, Peskind, ER, Turner, RS, Womack, KB & Zamrini, EY 2010, 'Validation of consensus panel diagnosis in dementia', Archives of Neurology, vol. 67, no. 12, pp. 1506-1512. https://doi.org/10.1001/archneurol.2010.301
Gabel MJ, Foster NL, Heidebrink JL, Higdon R, Aizenstein HJ, Arnold SE et al. Validation of consensus panel diagnosis in dementia. Archives of Neurology. 2010 Dec;67(12):1506-1512. https://doi.org/10.1001/archneurol.2010.301
Gabel, Matthew J. ; Foster, Norman L. ; Heidebrink, Judith L. ; Higdon, Roger ; Aizenstein, Howard J. ; Arnold, Steven E. ; Barbas, Nancy R. ; Boeve, Bradley F. ; Burke, James R. ; Clark, Christopher M. ; DeKosky, Steven T. ; Farlow, Martin R. ; Jagust, William J. ; Kawas, Claudia H. ; Koeppe, Robert A. ; Leverenz, James B. ; Lipton, Anne M. ; Peskind, Elaine R. ; Turner, R. Scott ; Womack, Kyle B. ; Zamrini, Edward Y. / Validation of consensus panel diagnosis in dementia. In: Archives of Neurology. 2010 ; Vol. 67, No. 12. pp. 1506-1512.
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AU - Gabel, Matthew J.

AU - Foster, Norman L.

AU - Heidebrink, Judith L.

AU - Higdon, Roger

AU - Aizenstein, Howard J.

AU - Arnold, Steven E.

AU - Barbas, Nancy R.

AU - Boeve, Bradley F.

AU - Burke, James R.

AU - Clark, Christopher M.

AU - DeKosky, Steven T.

AU - Farlow, Martin R.

AU - Jagust, William J.

AU - Kawas, Claudia H.

AU - Koeppe, Robert A.

AU - Leverenz, James B.

AU - Lipton, Anne M.

AU - Peskind, Elaine R.

AU - Turner, R. Scott

AU - Womack, Kyle B.

AU - Zamrini, Edward Y.

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N2 - 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 fludeoxyglucose 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.

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