Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study - Éducation Éthique Santé EA 7505 Accéder directement au contenu
Article Dans Une Revue Epidemiology and Public Health = Revue d'Epidémiologie et de Santé Publique Année : 2019

Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study

Résumé

Background: 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.Methods: 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.Results: 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).Conclusion: 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.
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hal-03463958 , version 1 (20-12-2021)

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E. Laurent, A. Lemaignen, G. Gras, J. Druon, K. Fèvre, et al.. Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study. Epidemiology and Public Health = Revue d'Epidémiologie et de Santé Publique, 2019, 67 (3), pp.149-154. ⟨10.1016/j.respe.2019.01.121⟩. ⟨hal-03463958⟩
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