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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
International management platform for children's interstitial lung disease (chILD-EU)
Matthias Griese1, Elias Seidl1, Meike Hengst1
1Department of Pediatric Pneumology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany.
Insights
An international platform for children's interstitial lung diseases (chILD) improved diagnosis accuracy. Multidisciplinary review confirmed diagnoses in many cases, highlighting the need for standardized subclassification training.
Area of Science:
- Pediatric Pulmonology
- Rare Diseases
- Medical Informatics
Background:
- Children's interstitial lung diseases (chILD) encompass rare, often undiagnosed conditions.
- There is a critical need for expert advice and standardized classification of chILD entities.
- An international registry is essential for comprehensive chILD research and management.
Purpose of the Study:
- To implement an international platform for chILD management and multidisciplinary case review.
- To assess the platform's ability to improve diagnostic accuracy in chILD.
- To evaluate the quality and reproducibility of a diagnostic subclassification system for chILD.
Main Methods:
- Development and implementation of a web-based chILD management platform with registry and biobank.
- Inclusion of 575 patients over 3 years, with multidisciplinary reviews conducted at five international sites.
- Assessment of diagnostic subclassification accuracy by nine expert clinicians using the chILD-EU classification.
Main Results:
- The platform facilitated the inclusion of 575 chILD patients, with 346 undergoing multidisciplinary review.
- Peer review led to diagnostic confirmation or refinement in 13% of cases initially diagnosed by referring teams.
- Expert clinicians achieved 64% inter-rater agreement in subcategorization after training, indicating usefulness but need for further standardization.
Conclusions:
- The chILD-EU platform provides a valuable tool for enhancing the clinical assessment of children's interstitial lung diseases.
- International collaboration and standardized review processes are crucial for accurate chILD diagnosis and management.
- Further training is recommended to optimize the implementation and consistency of chILD subclassification.
Background:
Children's interstitial lung diseases (chILD) cover many rare entities, frequently not diagnosed or studied in detail. There is a great need for specialised advice and for internationally agreed subclassification of entities collected in a register.Our objective was to implement an international management platform with independent multidisciplinary review of cases at presentation for long-term follow-up and to test if this would allow for more accurate diagnosis. Also, quality and reproducibility of a diagnostic subclassification system were assessed using a collection of 25 complex chILD cases.
Methods:
A web-based chILD management platform with a registry and biobank was successfully designed and implemented.
Results:
Over a 3-year period, 575 patients were included for observation spanning a wide spectrum of chILD. In 346 patients, multidisciplinary reviews were completed by teams at five international sites (Munich 51%, London 12%, Hannover 31%, Ankara 1% and Paris 5%). In 13%, the diagnosis reached by the referring team was not confirmed by peer review. Among these, the diagnosis initially given was wrong (27%), imprecise (50%) or significant information was added (23%).The ability of nine expert clinicians to subcategorise the final diagnosis into the chILD-EU register classification had an overall exact inter-rater agreement of 59% on first assessment and after training, 64%. Only 10% of the 'wrong' answers resulted in allocation to an incorrect category. Subcategorisation proved useful but training is needed for optimal implementation.
Conclusions:
We have shown that chILD-EU has generated a platform to help the clinical assessment of chILD.
Trial Registration Number:
Results, NCT02852928.
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