Identification of diagnostic criteria for chronic hypersensitivity pneumonitis: an international modified Delphi survey

Morisset, Julie, Johannson, Kerri A., Jones, Kirk D., Wolters, Paul J., Collard, Harold R., Walsh, Simon L.F. and Ley, Brett , HP Delphi Collaborators (2018) Identification of diagnostic criteria for chronic hypersensitivity pneumonitis: an international modified Delphi survey. American Journal of Respiratory and Critical Care Medicine, 197 (8), 1036-1044. (doi:10.1164/rccm.201710-1986OC).

Abstract

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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Contributors

Author: Mark Jones

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