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Multicriteria decision analysis process to develop new classification criteria for systemic lupus erythematosus.

ABSTRACT: European League Against Rheumatism and are jointly supporting multiphase development of systemic lupus erythematosus (SLE) classification criteria based on weighted criteria and a continuous probability scale. Prior steps included item generation, item reduction and hierarchical organisation of candidate criteria using an evidence-based approach. Our objectives were to determine relative weights using multicriteria decision analysis (MCDA) and to set a provisional threshold score for SLE classification. An SLE Expert Panel (8 European, 9 North American) submitted 164 real, unique cases with a wide range of SLE probability in a standardised format. Using the candidate criteria, experts scored and rank-ordered 20 representative cases. At an in-person meeting, experts reviewed inter-rater reliability of scoring, further refined criteria definitions and participated in an MCDA exercise. Based on expert consensus decisions on pairwise comparisons of criteria, 1000minds software calculated criteria weights and rank-ordered the remaining 144 cases based on their additive scores. The score of the lowest-ranked case for which complete expert consensus was achieved defined the provisional threshold classification score. Inter-rater reliability of scoring cases with the candidate criteria was good. MCDA involved 74 pairwise decisions and was repeated for the arthritis and mucocutaneous domains when the initial ranking of some cases did not match expert opinion. After criteria weights and additive scores were recalculated once, experts reached consensus for SLE classification for all cases scoring>83. Using an iterative process, the candidate criteria definitions were refined, preliminary weights were calculated and a provisional threshold score for SLE classification was determined.

SUBMITTER: Tedeschi SK

PROVIDER: S-EPMC7057251 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Multicriteria decision analysis process to develop new classification criteria for systemic lupus erythematosus.

Tedeschi Sara K SK Johnson Sindhu R SR Boumpas Dimitrios T DT Daikh David D Dörner Thomas T Diamond Betty B Jacobsen Søren S Jayne David D Kamen Diane L DL McCune W Joseph WJ Mosca Marta M Ramsey-Goldman Rosalind R Ruiz-Irastorza Guillermo G Schneider Matthias M Urowitz Murray M Wofsy David D Smolen Josef S JS Naden Raymond P RP Aringer Martin M Costenbader Karen H KH

Annals of the rheumatic diseases 20190128 5

European League Against Rheumatism and are jointly supporting multiphase development of systemic lupus erythematosus (SLE) classification criteria based on weighted criteria and a continuous probability scale. Prior steps included item generation, item reduction and hierarchical organisation of candidate criteria using an evidence-based approach. Our objectives were to determine relative weights using multicriteria decision analysis (MCDA) and to set a provisional threshold score for SLE classif ...[more]

PMID: 30692164

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Project description:ImportanceClassification criteria are the standardized definitions that are used to enroll uniform cohorts for research studies. They emphasize high specificity and are distinct from diagnostic criteria. No universally recognized classification criteria currently exist for discoid lupus erythematosus (DLE), which has led to problematic heterogeneity in observational and interventional clinical studies across the field.ObjectiveTo create and validate classification criteria for DLE using 12 previously defined candidate criteria items.Design, setting, and participantsFor this diagnostic study, candidate criteria items were prospectively applied by dermatologists and dermatopathologists at clinical visits of patients with DLE or a condition that could be confused for DLE, termed a DLE mimicker, at academic dermatology practices across the United States, Poland, Japan, and South Korea. Data were collected from December 1, 2017, to February 1, 2019, and analyzed from March 1 to September 19, 2019.Main outcomes and measuresClinical features among these 2 groups were calculated and compared with χ2 or Fisher exact tests. Candidate models were identified using best subsets logistic regression analysis. Improvement tests, fit statistics, and discrimination were considered to choose a final model.ResultsNine sites contributed 215 patients, 15 of whom had missing or incomplete data. The final model for DLE classification criteria includes only clinical variables: atrophic scarring (3 points), location in the conchal bowl (2 points), preference for the head and neck (2 points), dyspigmentation (1 point), follicular hyperkeratosis and/or plugging (1 point), and erythematous to violaceous in color (1 point), with an area under the receiving operating characteristic curve of 0.91 (95% CI, 0.87-0.95). A score of at least 5 points yields a sensitivity of 84.1% and a specificity of 75.9% in the classification of DLE, with increasing scores yielding higher specificity.Conclusions and relevanceThese findings provide the initial validation of classification criteria for DLE for use in observational and clinical trials.

Dataset Information

Multicriteria decision analysis process to develop new classification criteria for systemic lupus erythematosus.

Publications

Multicriteria decision analysis process to develop new classification criteria for systemic lupus erythematosus.

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