title: Development of appropriateness explicit criteria for cataract extraction by phacoemulsification.
abstract: BACKGROUND
  Consensus development techniques were used in the late 1980s to create explicit criteria for the appropriateness of cataract extraction. We developed a new appropriateness of indications tool for cataract following the RAND method. We tested the validity of our panel results.
  
  
  METHODS
  Criteria were developed using a modified Delphi panel judgment process. A panel of 12 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the influence of all variables on the final panel score using linear and logistic regression models. The explicit criteria developed were summarized by classification and regression tree analysis.
  
  
  RESULTS
  Of the 765 indications evaluated by the main panel in the second round, 32.9% were found appropriate, 30.1% uncertain, and 37% inappropriate. Agreement was found in 53% of the indications and disagreement in 0.9%. Seven variables were considered to create the indications and divided into three groups: simple cataract, with diabetic retinopathy, or with other ocular pathologies. The preoperative visual acuity in the cataractous eye and visual function were the variables that best explained the panel scoring. The panel results were synthesized and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel original criteria, was 5.3%.
  
  
  CONCLUSIONS
  The parameters tested showed acceptable validity for an evaluation tool. These results support the use of this indication algorithm as a screening tool for assessing the appropriateness of cataract extraction in field studies and for the development of practice guidelines.
authors.affiliation: Unidad de Investigación, Hospital de Galdakao, Galdakao, Vizcaya, Spain. jmquinta@hgda.osakidetza.net
authors.forename: José Ma
authors.initials: JM
authors.lastname: Quintana
authors.forename: Antonio
authors.initials: A
authors.lastname: Escobar
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Aróstegui
mesh_terms: D000203:Activities of Daily Living; D002386:Cataract / Q000145:classification / Q000175:diagnosis* / Q000473:pathology; D002985:Clinical Protocols; D000075202:Contraindications; D003663:Decision Trees; D003697:Delphi Technique; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D009885:Ophthalmology / Q000379:methods / Q000592:standards*; D018918:Phacoemulsification / Q000592:standards*; D011379:Prognosis; D013030:Spain; D016896:Treatment Outcome; D014792:Visual Acuity