Refining clinical algorithms for a neonatal digital platform for low-income countries: a modified Delphi technique.
Author(s)
Evans, Mari
Corden, Mark H
Crehan, Caroline
Fitzgerald, Felicity
Heys, Michelle
Type
Journal Article
Abstract
OBJECTIVES: To determine whether a panel of neonatal experts could address evidence gaps in local and international neonatal guidelines by reaching a consensus on four clinical decision algorithms for a neonatal digital platform (NeoTree). DESIGN: Two-round, modified Delphi technique. SETTING AND PARTICIPANTS: Participants were neonatal experts from high-income and low-income countries (LICs). METHODS: This was a consensus-generating study. In round 1, experts rated items for four clinical algorithms (neonatal sepsis, hypoxic ischaemic encephalopathy, respiratory distress of the newborn, hypothermia) and justified their responses. Items meeting consensus for inclusion (≥80% agreement) were incorporated into the algorithms. Items not meeting consensus were either excluded, included following revisions or included if they contained core elements of evidence-based guidelines. In round 2, experts rated items from round 1 that did not reach consensus. RESULTS: Fourteen experts participated in round 1, 10 in round 2. Nine were from high-income countries, five from LICs. Experts included physicians and nurse practitioners with an average neonatal experience of 20 years, 12 in LICs. After two rounds, a consensus was reached on 43 of 84 items (52%). Per experts' recommendations, items in line with local and WHO guidelines yet not meeting consensus were still included to encourage consistency for front-line healthcare workers. As a result, the final algorithms included 53 items (62%). CONCLUSION: Four algorithms in a neonatal digital platform were reviewed and refined by consensus expert opinion. Revisions to NeoTree will be made in response to these findings. Next steps include clinical validation of the algorithms.
Date Issued
2021-05-18
Date Acceptance
2021-04-01
Citation
BMJ Open, 2021, 11 (5), pp.e042124-e042124
ISSN
2044-6055
Publisher
BMJ Journals
Start Page
e042124
End Page
e042124
Journal / Book Title
BMJ Open
Volume
11
Issue
5
Copyright Statement
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/34006538
PII: bmjopen-2020-042124
Subjects
information technology
neonatal intensive & critical care
neonatology
public health
Algorithms
Consensus
Delphi Technique
Humans
Infant, Newborn
Physicians
Poverty
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2021-05-18