Idiopathic interstitial pneumonia: Do community and academic physicians agree on diagnosis?

Kevin R. Flaherty, Adin Cristian Andrei, Talmadge E. King, Ganesh Raghu, Thomas V. Colby, Athol Wells, Nadir Bassily, Kevin Brown, Roland Du Bois, Andrew Flint, Steven E. Gay, Barry H. Gross, Ella A. Kazerooni, Robert Knapp, Edmund Louvar, David Lynch, Andrew G. Nicholson, John Quick, Victor J. Thannickal, William D. TravisJames Vyskocil, Frazer A. Wadenstorer, Jeffrey Wilt, Galen B. Toews, Susan Murray, Fernando J. Martinez

Research output: Contribution to journalArticle

167 Scopus citations

Abstract

Rationale: Treatment and prognoses of diffuse parenchymal lung diseases (DPLDs) varies by diagnosis. Obtaining a uniform diagnosis among observers is difficult. Objectives: Evaluate diagnostic agreement between academic and community-based physicians for patients with DPLDs, and determine if an interactive approach between clinicians, radiologists, and pathologists improved diagnostic agreement in community and academic centers. Methods: Retrospective review of 39 patients with DPLD. A total of 19 participants reviewed cases at 2 community locations and 1 academic location. Information from the history, physical examination, pulmonary function testing, high-resolution computed tomography, and surgical lung biopsy was collected. Data were presented in the same sequential fashion to three groups of physicians on separate days. Measurements and Main Results: Each observer's diagnosis was coded into one of eight categories. A κ statistic allowing for multiple raters was used to assess agreement in diagnosis. Interactions between clinicians, radiologists, and pathologists improved interobserver agreement at both community and academic sites; however, final agreement was better within academic centers (κ = 0.55-0.71) than within community centers (κ = 0.32-0.44). Clinically significant disagreement was present between academic and community-based physicians (κ = 0.11-0.56). Community physicians were more likely to assign a final diagnosis of idiopathic pulmonary fibrosis compared with academic physicians. Conclusions: Significant disagreement exists in the diagnosis of DPLD between physicians based in communities compared with those in academic centers. Wherever possible, patients should be referred to centers with expertise in diffuse parenchymal lung disorders to help clarify the diagnosis and provide suggestions regarding treatment options.

Original languageEnglish (US)
Pages (from-to)1054-1060
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume175
Issue number10
DOIs
StatePublished - May 15 2007

Keywords

  • Academic
  • Community
  • Diagnosis
  • Nonspecific interstitial pneumonia
  • Usual interstitial pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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    Flaherty, K. R., Andrei, A. C., King, T. E., Raghu, G., Colby, T. V., Wells, A., Bassily, N., Brown, K., Du Bois, R., Flint, A., Gay, S. E., Gross, B. H., Kazerooni, E. A., Knapp, R., Louvar, E., Lynch, D., Nicholson, A. G., Quick, J., Thannickal, V. J., ... Martinez, F. J. (2007). Idiopathic interstitial pneumonia: Do community and academic physicians agree on diagnosis? American journal of respiratory and critical care medicine, 175(10), 1054-1060. https://doi.org/10.1164/rccm.200606-833OC