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Published on: May 9, 2018
Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis: An International Modified Delphi
Julie Morisset1, Kerri A Johannson2, Kirk D Jones3
1Centre Hospitalier de L'Universite de Montreal, 25443, Montreal, Quebec, Canada ; julie.morisset@umontreal.ca.
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.
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