Expert surgical consensus for prenatal counseling using the Delphi method
Loren Berman1, Jordan Jackson2, Kristen Miller3
1Sidney Kimmel Medical College of Thomas Jefferson University, 1025 Walnut St. #100, Philadelphia, PA 19107, USA; Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA.
Insights
Pediatric surgeons lack consensus on managing congenital pulmonary airway malformation (CPAM) and congenital diaphragmatic hernia (CDH). A Delphi study established expert guidelines for perinatal care of these conditions.
Area of Science:
- Pediatric Surgery
- Fetal Medicine
- Neonatal Care
Background:
- Lack of evidence-based guidelines for prenatal counseling in CPAM and CDH.
- Need for expert consensus on best practices for these congenital anomalies.
- Prenatal consultation is common but lacks standardized approaches.
Purpose of the Study:
- To establish expert consensus on perinatal management guidelines for CPAM and CDH.
- To address discrepancies in current literature regarding these conditions.
- To inform prenatal decision-making and counseling.
Main Methods:
- Delphi consensus process involving pediatric surgical experts in fetal therapy.
- Online surveys to identify and resolve discrepancies in CPAM and CDH management.
- Two rounds of surveys to achieve consensus on key questions.
Main Results:
- Consensus reached on 61% of initial questions (54/89) in round one.
- 88% consensus achieved on 60 questions in the second round (53/60).
- 54 surgeons participated across two survey rounds.
Conclusions:
- Expert consensus was achieved for perinatal management guidelines of CPAM and CDH.
- These guidelines will aid pediatric surgeons in providing perinatal care.
- The study provides a foundation for evidence-based counseling and intervention.
Background:
Pediatric surgeons frequently offer prenatal consultation for congenital pulmonary airway malformation (CPAM) and congenital diaphragmatic hernia (CDH); however, there is no evidence-based consensus to guide prenatal decision making and counseling for these conditions. Eliciting feedback from experts is integral to defining best practice regarding prenatal counseling and intervention.
Methods:
A Delphi consensus process was undertaken using a panel of pediatric surgeons identified as experts in fetal therapy to address current limitations. Areas of discrepancy in the literature on CPAM and CDH were identified and used to generate a list of content and intervention questions. Experts were invited to participate in an online Delphi survey. Items that did not reach first-round consensus were broken down into additional questions, and consensus was achieved in the second round.
Results:
Fifty-four surgeons (69%) responded to at least one of the two survey rounds. During round one, consensus was reached on 54 of 89 survey questions (61%), and 45 new questions were developed. During round two, consensus was reached on 53 of 60 survey questions (88%).
Conclusions:
We determined expert consensus to establish guidelines regarding perinatal management of CPAM and CDH. Our results can help educate pediatric surgeons participating in perinatal care of these patients.
Level Of Evidence:
V.
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