Chulalongkorn Comprehensive Epilepsy Center of Excellence, The Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Clin Neurosci. 2020 Feb;72:84-92. doi: 10.1016/j.jocn.2020.01.008. Epub 2020 Jan 23.
To establish a consensus which is practical and ready-to-use on investigations (ISE) and for management of status epilepticus (MSE) in adults using a modified Delphi approach.
A 4-round modified Delphi approach was used. First and second rounds were conducted using Google® survey with structured statements and 6-point Likert scale response. Threshold agreement was set to ≥80%. Third round was a face-to-face meeting aimed to facilitate the development of approach algorithms for ISE and MSE. Fourth round was a final review asking participants to rate the algorithms post completion.
The panel consisted of 8 board-certified epileptologists along with 6 neurologists from main regional hospitals across Thailand. Thirty-seven statements for ISE and 68 statements for MSE were used for the Round I survey, 17/37 (45.9%) and 49/68 (72.1%) reached threshold agreement (≥80%). The average absolute-agreement intraclass correlation coefficients for ISE and MSE were 0.82 (95% CI 0.71, 0.89) and 0.81 (95% CI 0.73, 0.87), respectively; indicating good extent of consensus among participants. Upon Round II, further 10/18 (55.6%) for ISE and 10/19 (52.6%) for MSE reached agreement. In Round III, face-to-face point-by-point discussion was performed to generate approach algorithms. All (100%) provided positive responses with the algorithms post completion in Round IV.
A practical and ready-to-use consensus using modified Delphi approach on ISE and MSE was developed in a Thai regional hospital context. In real practice, this approach is more suitable and feasible for a localized setting when compared with totally adopting international guidelines.
采用改良 Delphi 法就成人癫痫持续状态的检查（ISE）和处理（MSE）达成实用且可即刻应用的共识。
采用 4 轮改良 Delphi 法。第一轮和第二轮采用 Google®调查进行，使用结构化语句和 6 分李克特量表作答。共识阈值设定为≥80%。第三轮为面对面会议，旨在为 ISE 和 MSE 的处理方法制定提供便利。第四轮为最终审查，要求参与者在完成后对算法进行评分。
该小组由 8 位癫痫学专家和来自泰国各大区域医院的 6 位神经病学家组成。第一轮调查使用了 37 项 ISE 和 68 项 MSE 的陈述，17/37（45.9%）和 49/68（72.1%）达到共识阈值（≥80%）。ISE 和 MSE 的平均绝对一致组内相关系数分别为 0.82（95%置信区间 0.71，0.89）和 0.81（95%置信区间 0.73，0.87），表明参与者之间具有良好的共识程度。第二轮调查中，10/18（55.6%）的 ISE 和 10/19（52.6%）的 MSE 达到了共识。在第三轮调查中，进行了面对面的逐点讨论，以生成处理方法。在第四轮调查中，所有（100%）参与者在完成算法后都给予了积极的回应。
在泰国区域医院背景下，采用改良 Delphi 法就 ISE 和 MSE 达成了实用且可即刻应用的共识。在实际应用中，与完全采用国际指南相比，这种方法更适合和可行本地化设置。
