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Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study
E Laurent1, A Lemaignen2, G Gras3
1Public 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.
Revue D'Epidemiologie Et De Sante Publique
|March 6, 2019
Summary
Physician agreement on classifying complex bone and joint infections (CBJI) was moderate. Multidisciplinary team meetings (MTMs) showed better agreement than individual experts, suggesting MTMs may improve diagnostic consistency for severe infections.
Area of Science:
- Infectious Diseases
- Medical Diagnostics
- Health Services Research
Background:
- Complex bone and joint infections (CBJI) are severe cases managed by multidisciplinary team meetings (MTMs) in French reference centers.
- Physician consensus on the definition of CBJI remains a challenge.
- This study aimed to evaluate the agreement in CBJI classification among physicians.
Purpose of the Study:
- To estimate the level of agreement in classifying complex bone and joint infections (CBJI).
- To compare inter-expert and inter-multidisciplinary team meeting (MTM) agreement for CBJI classification.
- To assess the impact of experience and MTM characteristics on classification agreement.
Main Methods:
- Five experts initially classified 24 cases twice, a month apart, using full medical records.
- Six MTMs subsequently classified the same cases using standardized information.
- Agreement was quantified using Fleiss and Cohen kappa coefficients (κ).
Main Results:
- Inter-expert agreement within one MTM was moderate (κ=0.49).
- Overall inter-MTM agreement was moderate (κ=0.58), improving with senior staff and longer case review times.
- Excluding non-BJI cases reduced overall agreement (κ=0.40).
Conclusions:
- Heterogeneity in CBJI classification among experts was confirmed.
- MTMs demonstrated better agreement than individual experts, highlighting their role in standardizing care.
- Further research is needed to evaluate MTM impact on patient outcomes and healthcare economics.
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