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- Title
Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis: An International Modified Delphi Survey.
- Authors
Morisset, Julie; Johannson, Kerri A.; Jones, Kirk D.; Wolters, Paul J.; Collard, Harold R.; Walsh, Simon L. F.; Ley, Brett; HP Delphi Collaborators
- Abstract
<bold>Rationale: </bold>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.<bold>Objectives: </bold>We aimed to identify diagnostic criteria for cHP that reach consensus among international experts.<bold>Methods: </bold>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.<bold>Measurements and Main Results: </bold>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.<bold>Conclusion: </bold>This consensus-based approach for the diagnosis of cHP represents a first step towards the development of international guidelines for the diagnosis of cHP.
- Publication
American Journal of Respiratory & Critical Care Medicine, 2018, Vol 197, Issue 8, p1036
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201710-1986OC