E Laurent1, A Lemaignen2, G Gras3, J Druon4, K Fèvre3, P Abgueguen5, G Le Moal6, E Stindel7, A-S Domelier8, S Touchais9, C Arvieux10, L Bernard2, P Rosset11, L Grammatico-Guillon12. 1. Public health unit, epidemiology, teaching hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France; Research team EE1 EES, university of Tours, 10, boulevard Tonnellé, 37000 Tours, France; Faculté de Médecine, Université de Tours, France. 2. Faculté de Médecine, Université de Tours, France; Infectious diseases unit, teaching hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France. 3. Infectious diseases unit, teaching hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France. 4. Orthopedic unit, teaching hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France. 5. Infectious diseases unit, teaching hospital of Angers, 4, rue Larrey, 49100 Angers, France. 6. Infectious diseases unit, teaching hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France. 7. Orthopedic unit, teaching hospital of Brest, 2, avenue Foch, 29609 Brest, France. 8. Laboratory of microbiology, teaching hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France. 9. Orthopedic unit, teaching hospital of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France. 10. Infectious diseases unit, teaching hospital of Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France. 11. Faculté de Médecine, Université de Tours, France; Orthopedic unit, teaching hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France. 12. Public health unit, epidemiology, teaching hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France; Faculté de Médecine, Université de Tours, France. Electronic address: leslie.guillon@univ-tours.fr.
Abstract
BACKGROUND: In France, the most severe bone and joint infections (BJI), called "complex" (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification. METHODS: Initially, five experts from one MTM classified twice, one-month apart, 24 cases as non-BJI, simple BJI or CBJI, using the complete medical record. Secondly, six MTMs classified the same cases using standardized information. Agreements were estimated using Fleiss and Cohen kappa (κ) coefficients. RESULTS: Inter-expert agreement during one MTM was moderate (κ=0.49), and fair (κ=0.23) when the four non-BJIs were excluded. Intra-expert agreement was moderate (κ=0.50, range 0.27-0.90), not improved with experience. The overall inter-MTM agreement was moderate (κ=0.58), it was better between MTMs with professor (κ=0.65) than without (κ=0.51) and with longer median time per case (κ=0.60) than shorter (κ=0.47). When the four non-BJIs were excluded, the overall agreement decreased (κ=0.40). CONCLUSION: The first step confirmed the heterogeneity of CBJI classification between experts. The seemingly better inter-MTM than inter-expert agreement could be an argument in favour of MTMs, which are moreover a privileged place to enhance expertise. Further studies are needed to assess these results as well as the quality of care and medico-economic outcomes after a MTM.
BACKGROUND: In France, the most severe bone and joint infections (BJI), called "complex" (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification. METHODS: Initially, five experts from one MTM classified twice, one-month apart, 24 cases as non-BJI, simple BJI or CBJI, using the complete medical record. Secondly, six MTMs classified the same cases using standardized information. Agreements were estimated using Fleiss and Cohen kappa (κ) coefficients. RESULTS: Inter-expert agreement during one MTM was moderate (κ=0.49), and fair (κ=0.23) when the four non-BJIs were excluded. Intra-expert agreement was moderate (κ=0.50, range 0.27-0.90), not improved with experience. The overall inter-MTM agreement was moderate (κ=0.58), it was better between MTMs with professor (κ=0.65) than without (κ=0.51) and with longer median time per case (κ=0.60) than shorter (κ=0.47). When the four non-BJIs were excluded, the overall agreement decreased (κ=0.40). CONCLUSION: The first step confirmed the heterogeneity of CBJI classification between experts. The seemingly better inter-MTM than inter-expert agreement could be an argument in favour of MTMs, which are moreover a privileged place to enhance expertise. Further studies are needed to assess these results as well as the quality of care and medico-economic outcomes after a MTM.
Keywords:
Agreement; Complex bone and joint infection; Concordance; Infection ostéoarticulaire; Multidisciplinary team meeting; Réunion de concertation pluridisciplinaire; complexe
Authors: Adrien Lemaignen; Leslie Grammatico-Guillon; Pascal Astagneau; Simon Marmor; Tristan Ferry; Anne Jolivet-Gougeon; Eric Senneville; Louis Bernard Journal: Bone Joint Res Date: 2020-10-10 Impact factor: 5.853