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

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 (k) coefficients. Results. - Inter-expert agreement during one MTM was moderate (k = 0.49), and fair (k = 0.23) when the four non-BJIs were excluded. Intra-expert agreement was moderate (k = 0.50, range 0.27-0.90), not improved with experience. The overall inter-MTM agreement was moderate (k = 0.58), it was better between MTMs with professor (k = 0.65) than without (k = 0.51) and with longer median time per case (k = 0.60) than shorter (k = 0.47). When the four non-BJIs were excluded, the overall agreement decreased (k = 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. (C) 2019 Elsevier Masson SAS. All rights reserved.