Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
EULAR and ACR are supporting multi-phase development of SLE classification criteria based on weighted criteria and a continuous probability scale. Prior steps included criteria generation, criteria reduction through Delphi and Nominal Group Technique exercises, literature review for sensitivity/specificity of candidate criteria, and organization of candidate criteria into seven clinical and three immunologic domains. Our next goals were to refine definitions of candidate criteria, determine relative weights using multicriteria decision analysis (MCDA), and identify a threshold score on a continuous scale for SLE classification.
An SLE Expert Panel (9 North American, 8 European) submitted 167 unique cases, with range of SLE probability. Experts scored 20 representative cases using the candidate criteria and rank-ordered them. In a two day meeting, experts reviewed inter-rater reliability of scoring, refined criteria definitions, and participated in a MCDA exercise using 1000MindsTM software. Experts were presented with a series of decisions between two cases, each with different criteria from two domains (e.g. oral ulcers [cutaneous] and acute pericarditis [serositis] vs. alopecia [cutaneous] and pleural effusion [serositis]). Experts anonymously voted for the case more likely to be classified as SLE. Votes were discussed until consensus was reached for each decision. Using the consensus decisions, 1000MindsTM calculated criteria weights, assigned a total score to each of remaining 147 cases and rank-ordered the cases. Experts voted on whether each case should be classified as SLE. The score of the last case for which consensus was achieved was the threshold score. Experts repeated the MCDA for criteria whose calculated weights were inconsistent with expert opinion until group consensus was achieved.
Inter-rater reliability was good; human data entry error, not following instructions, and differing interpretations of criteria definitions accounted for discrepancies. Arthritis and pericarditis definitions were modified through group discussion. The MCDA involved 74 pairwise decisions. Cranial neuropathy and Class VI lupus nephritis were removed as they added little to SLE classification. MCDA was repeated for the arthritis and cutaneous domains as initial weights did not match expert opinion. Criteria weights and scores were re-calculated. Experts reached consensus for SLE classification for case scores >83.
Using an iterative process, the expert panel refined and weighted candidate criteria definitions and determined a threshold score of >83 for SLE classification. Validation is the next step.
To cite this abstract in AMA style:Tedeschi SK, Johnson S, Boumpas D, Daikh DI, Diamond B, Doerner T, Jacobsen S, Kamen DL, McCune WJ, Mosca M, Ramsey-Goldman R, Ruiz-Irastorza G, Schneider M, Smolen JS, Urowitz M, Wofsy D, Aringer M, Naden RP, Costenbader KH. A Multicriteria Decision Analysis for the Development of New Systemic Lupus Erythematosus Classification Criteria [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/a-multicriteria-decision-analysis-for-the-development-of-new-systemic-lupus-erythematosus-classification-criteria/. Accessed September 20, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-multicriteria-decision-analysis-for-the-development-of-new-systemic-lupus-erythematosus-classification-criteria/