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• W2920367002 abstract "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. 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. 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). 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. En France, les infections ostéoarticulaires (IOA) les plus sévères, dites « complexes », doivent être validées en réunion de concertation pluridisciplinaire (RCP) dans un centre de référence. Cependant, la définition ministérielle d’IOA complexe a une interprétation clinique potentiellement variable. L’objectif était d’analyser l’accord pour le diagnostic d’IOA complexe, entre experts d’une même RCP et entre RCP de six centres de référence. Premièrement, cinq experts d’une RCP devaient classer à deux reprises à un mois d’intervalle 24 cas en non-IOA, IOA simple ou IAO complexe, à l’aide du dossier médical. Deuxièmement, six RCP ont validé les 24 mêmes cas, standardisés. Les accords ont été estimés par les coefficients kappa (κ) de Cohen et Fleiss. L’accord inter-expert global était modéré (κ = 0,49). Après exclusion des quatre non-IOA, l’accord était médiocre (κ = 0,23) ; l’accord intra-expert était modéré (κ = 0,50, étendue [0,27–0,90]), non amélioré par l’expérience. L’accord inter-RCP global était modéré (κ = 0,58) et semblait plus élevé pour les RCP avec professeur(s) (κ = 0,65 vs κ = 0,51), ainsi que pour celles ayant un temps médian par cas plus long (κ = 0,60 vs κ = 0,47). Après exclusion des quatre non-IOA, l’accord global valait κ = 0,40. La première étape a confirmé l’hétérogénéité du classement en IOA complexe selon l’expert. L’accord inter-RCP, qui semblait plus élevé, serait un argument en faveur des RCP, par ailleurs lieu privilégié d’amélioration de l’expertise clinique. Ces résultats, à confirmer, nécessitent d’être complétés par une évaluation de la qualité de la prise en charge et de l’impact médico-économique des RCP." @default.
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• W2920367002 date "2019-05-01" @default.
• W2920367002 modified "2023-10-01" @default.
• W2920367002 title "Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study" @default.
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• W2920367002 doi "https://doi.org/10.1016/j.respe.2019.01.121" @default.
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