Julie Morisset1, Kerri A Johannson2, Kirk D Jones3, Paul J Wolters4, Harold R Collard5, Simon L F Walsh6, Brett Ley7. 1. Centre Hospitalier de L'Universite de Montreal, 25443, Montreal, Quebec, Canada ; julie.morisset@umontreal.ca. 2. University of Calgary, Medicine, Calgary, Canada ; Kerri.Johannson@albertahealthservices.ca. 3. University of California, San Francisco, Pathology, San Francisco, California, United States ; Kirk.Jones@ucsf.edu. 4. University of California, Medicine/CVRI, San Francisco, California, United States ; paul.wolters@ucsf.edu. 5. University of California, San Francisco, Department of Medicine, San Francisco, California, United States ; hal.collard@ucsf.edu. 6. King's College, Hospital NHS Foundation Trust, Department of Radiology, London, United Kingdom of Great Britain and Northern Ireland ; slfwalsh@gmail.com. 7. University of California, San Francisco, Department of Medicine, San Francisco, California, United States ; brett.ley@ucsf.edu.
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.
RATIONALE: Current diagnosis of chronic hypersensitivitypneumonitis (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.
Authors: Kerri A Johannson; Brett M Elicker; Eric Vittinghoff; Deborah Assayag; Kaïssa de Boer; Jeffrey A Golden; Kirk D Jones; Talmadge E King; Laura L Koth; Joyce S Lee; Brett Ley; Paul J Wolters; Harold R Collard Journal: Thorax Date: 2016-05-31 Impact factor: 9.139
Authors: Ping Wang; Kirk D Jones; Anatoly Urisman; Brett M Elicker; Thomas Urbania; Kerri A Johannson; Deborah Assayag; Joyce Lee; Paul J Wolters; Harold R Collard; Laura L Koth Journal: Chest Date: 2017-02-20 Impact factor: 9.410
Authors: Traci N Adams; Chad A Newton; Kiran Batra; Muhanned Abu-Hijleh; Tyonn Barbera; Jose Torrealba; Craig S Glazer Journal: Lung Date: 2018-06-29 Impact factor: 2.584
Authors: Haruhiko Furusawa; Jonathan H Cardwell; Tsukasa Okamoto; Avram D Walts; Iain R Konigsberg; Jonathan S Kurche; Tami J Bang; Marvin I Schwarz; Kevin K Brown; Jonathan A Kropski; Mauricio Rojas; Carlyne D Cool; Joyce S Lee; Paul J Wolters; Ivana V Yang; David A Schwartz Journal: Am J Respir Crit Care Med Date: 2020-11-15 Impact factor: 21.405
Authors: L Bergantini; P Cameli; M d'Alessandro; C Vagaggini; R M Refini; C Landi; M G Pieroni; M Spalletti; P Sestini; E Bargagli Journal: Clin Exp Med Date: 2019-09-04 Impact factor: 3.984
Authors: Margaret L Salisbury; Jeffrey L Myers; Elizabeth A Belloli; Ella A Kazerooni; Fernando J Martinez; Kevin R Flaherty Journal: Am J Respir Crit Care Med Date: 2018-06-15 Impact factor: 21.405