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Haematologica 2018 Volume 103(10):1698-1707
Ferrata Storti Foundation
Stem Cell Transplantation
The eGVHD App has the potential to improve the accuracy of graft-versus-host disease assessment: a multicenter randomized controlled trial
Helene M. Schoemans,1,2 Kathy Goris,1 Raf Van Durm,3 Steffen Fieuws,4 Sabina De Geest,2,5 Steven Z. Pavletic,6 Annie Im,7 Daniel Wolff,8
Stephanie J. Lee,9 Hildegard Greinix,10 Rafael F. Duarte,11 Xavier Poiré,12 Dominik Selleslag,13 Philippe Lewalle,14 Tessa Kerre,15 Carlos Graux,16
Frédéric Baron,17 Johan A. Maertens1 and Fabienne Dobbels;2 on behalf of the EBMT Transplantation Complications Working party
1Department of Hematology, University Hospitals Leuven and KU Leuven, Belgium; 2Academic Centre for Nursing and Midwifery, KU Leuven, Belgium; 3IT Department, University Hospitals Leuven, KU Leuven, Belgium; 4L-BioStat, KU Leuven – University of Leuven & Universiteit Hasselt, Leuven, Belgium; 5Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; 6Experimental Transplantation and Immunology Branch, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA; 7University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 8Department of Hematology and Clinical Oncology, University of Regensburg, Germany; 9Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; 10Division of Hematology, Medical University of Graz, Austria; 11ICO/Hospital Duran I Reynals, Hospitalet De Llobregat, Spain; 12Cliniques Universitaires Saint-Luc, Brussels, Belgium; 13Department of Hematology, AZ Sint-Jan Brugge, Belgium; 14Institut Jules Bordet - Université Libre de Bruxelles, Belgium; 15Hematology and Stem Cell Transplantation, Ghent University Hospital, Belgium; 16Université Catholique de Louvain, CHU UCL Namur (Godinne site), Yvoir, Belgium and 17Hematology, University of Liège, GIGA-I3, Belgium
ABSTRACT
Graft-versus-host disease (GvHD) assessment has been shown to be a challenge for healthcare professionals, leading to the devel- opment of the eGVHD App (www.uzleuven.be/egvhd). In this study, we formally evaluated the accuracy of using the App compared to traditional assessment methods to assess GvHD. Our national mul- ticenter randomized controlled trial involved seven Belgian transplan- tation centers and 78 healthcare professionals selected using a 2-stage convenience sampling approach between January and April 2017. Using a 1:1 randomization stratified by profession, healthcare profes- sionals were assigned to use either the App (“APP”) or their usual GvHD assessment aids (“No APP”) to assess the diagnosis and severity score of 10 expert-validated clinical vignettes. Our main outcome measure was the difference in accuracy for GvHD severity scoring between both groups. The odds of being correct were 6.14 (95%CI: 2.83-13.34) and 6.29 (95%CI: 4.32-9.15) times higher in favor of the “APP” group for diagnosis and scoring, respectively (P<0.001). App- assisted GvHD severity scoring was significantly superior for both acute and chronic GvHD, with an Odds Ratio of 17.89 and 4.34 respec- tively (P<0.001) and showed a significantly increased inter-observer agreement compared to standard practice. Despite a mean increase of 24 minutes (95%CI: 20.45-26.97) in the time needed to score the whole GvHD test package in the “APP” group (P<0.001), usability feedback was positive. The eGVHD App shows superior GvHD assessment accuracy compared to standard practice and has the potential to improve the quality of outcome data registration in allogeneic stem cell transplantation.
Correspondence:
helene.schoemans@uzleuven.be
Received: March 6, 2018. Accepted: June 13, 2018. Pre-published: June 14, 2018.
doi:10.3324/haematol.2018.190777
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/103/10/1698
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