title: Validation of consensus panel diagnosis in dementia.
abstract: BACKGROUND
  The clinical diagnosis of dementing diseases largely depends on the subjective interpretation of patient symptoms. Consensus panels are frequently used in research to determine diagnoses when definitive pathologic findings are unavailable. Nevertheless, research on group decision making indicates that many factors can adversely affect panel performance.
  
  
  OBJECTIVE
  To determine conditions that improve consensus panel diagnosis.
  
  
  METHODS
  Comparison of neuropathologic diagnoses with individual and consensus panel diagnoses based on clinical scenarios only, fludeoxyglucose F 18 positron emission tomography images only, and scenarios plus images.
  
  
  METHODS
  Expert and trainee individual and consensus panel deliberations using a modified Delphi method in a pilot research study of the diagnostic utility of fludeoxyglucose F 18 positron emission tomography.
  
  
  METHODS
  Forty-five patients with pathologically confirmed Alzheimer disease or frontotemporal dementia.
  
  
  METHODS
  Statistical measures of diagnostic accuracy, agreement, and confidence for individual raters and panelists before and after consensus deliberations.
  
  
  RESULTS
  The consensus protocol using trainees and experts surpassed the accuracy of individual expert diagnoses when clinical information elicited diverse judgments. In these situations, consensus was 3.5 times more likely to produce positive rather than negative changes in the accuracy and diagnostic certainty of individual panelists. A rule that forced group consensus was at least as accurate as majority and unanimity rules.
  
  
  CONCLUSIONS
  Using a modified Delphi protocol to arrive at a consensus diagnosis is a reasonable substitute for pathologic information. This protocol improves diagnostic accuracy and certainty when panelist judgments differ and is easily adapted to other research and clinical settings while avoiding the potential pitfalls of group decision making.
authors.affiliation: Department of Political Science, Washington University, St Louis, MO 63130-4899, USA. mgabel@artsci.wustl.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gabel
authors.forename: Norman L
authors.initials: NL
authors.lastname: Foster
authors.forename: Judith L
authors.initials: JL
authors.lastname: Heidebrink
authors.forename: Roger
authors.initials: R
authors.lastname: Higdon
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Aizenstein
authors.forename: Steven E
authors.initials: SE
authors.lastname: Arnold
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Barbas
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Boeve
authors.forename: James R
authors.initials: JR
authors.lastname: Burke
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Clark
authors.forename: Steven T
authors.initials: ST
authors.lastname: Dekosky
authors.forename: Martin R
authors.initials: MR
authors.lastname: Farlow
authors.forename: William J
authors.initials: WJ
authors.lastname: Jagust
authors.forename: Claudia H
authors.initials: CH
authors.lastname: Kawas
authors.forename: Robert A
authors.initials: RA
authors.lastname: Koeppe
authors.forename: James B
authors.initials: JB
authors.lastname: Leverenz
authors.forename: Anne M
authors.initials: AM
authors.lastname: Lipton
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Peskind
authors.forename: R Scott
authors.initials: RS
authors.lastname: Turner
authors.forename: Kyle B
authors.initials: KB
authors.lastname: Womack
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Zamrini
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D032921:Consensus; D019788:Fluorodeoxyglucose F18; D057180:Frontotemporal Dementia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D019788:Fluorodeoxyglucose F18