Laurens J De Sadeleer1, Caressa Meert2, Jonas Yserbyt1, Hans Slabbynck3, Johny A Verschakelen4, Eric K Verbeken5, Birgit Weynand5, Ellen De Langhe6, Jan L Lenaerts6, Benoit Nemery7, Dirk Van Raemdonck8, Geert M Verleden1, Athol U Wells9, Wim A Wuyts10. 1. Department of Pneumology, University Hospitals Leuven, Belgium. 2. Department of Internal Medicine, University Hospitals Leuven, Belgium. 3. Department of Pneumology, Middelheim-ZNA (Ziekenhuis Netwerk Antwerpen), Antwerp, Belgium. 4. Department of Radiology, University Hospitals Leuven, Belgium. 5. Department of Pathology, University Hospitals Leuven, Belgium. 6. Department of Rheumatology, University Hospitals Leuven, Belgium. 7. Department of Public Health and Primary Care, University Hospitals Leuven, Belgium. 8. Department of Thoracic Surgery, University Hospitals Leuven, Belgium. 9. Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England. 10. Department of Pneumology, University Hospitals Leuven, Belgium. Electronic address: wim.wuyts@uzleuven.be.
Abstract
BACKGROUND: The advice of a dynamic multidisciplinary discussion (MDD) is believed to be important in the diagnosis of interstitial lung diseases (ILDs). However, to what extent MDD diagnoses differ from the preliminary diagnoses before formal workup and MDD (preMDD diagnoses) is still insufficiently studied. METHODS: We compared preMDD and MDD diagnoses in patients discussed at the Leuven University Hospitals MDDs between January 2005 and December 2015. RESULTS: Of 938 consecutive patients discussed in an MDD, 755 (80.5%) received a specific diagnosis. From the 183 patients with unclassifiable ILD, 150 patients (16.0%) received suggestions concerning further investigations to establish a definite diagnosis. In 191 patients (41.9% of patients with a preMDD diagnosis), the MDD changed the diagnosis. In 384 patients (79.5% of patients without preMDD diagnosis), MDD provided a diagnosis when the referring physician did not. MDD diagnosis showed a trend toward better prognostic discrimination between idiopathic pulmonary fibrosis and other ILDs compared with preMDD diagnosis (Harrell C-index, 0.666 vs 0.631; P = .08), which was particularly clear in patients with discordant MDD and preMDD diagnoses (hazard ratio, 2.68 vs 0.84; P = .012 vs .768). CONCLUSIONS: The MDD provided a definite diagnosis in 80.5% of presented cases, suggesting further investigations in almost all others. Given the high number of patients without preMDD diagnosis, the rate of change in preMDD diagnoses (41.9% of patients with a preMDD diagnosis) probably is an underestimation. The better prognostic discrimination among ILDs by using MDD indicates the added value of MDD in ILD.
BACKGROUND: The advice of a dynamic multidisciplinary discussion (MDD) is believed to be important in the diagnosis of interstitial lung diseases (ILDs). However, to what extent MDD diagnoses differ from the preliminary diagnoses before formal workup and MDD (preMDD diagnoses) is still insufficiently studied. METHODS: We compared preMDD and MDD diagnoses in patients discussed at the Leuven University Hospitals MDDs between January 2005 and December 2015. RESULTS: Of 938 consecutive patients discussed in an MDD, 755 (80.5%) received a specific diagnosis. From the 183 patients with unclassifiable ILD, 150 patients (16.0%) received suggestions concerning further investigations to establish a definite diagnosis. In 191 patients (41.9% of patients with a preMDD diagnosis), the MDD changed the diagnosis. In 384 patients (79.5% of patients without preMDD diagnosis), MDD provided a diagnosis when the referring physician did not. MDD diagnosis showed a trend toward better prognostic discrimination between idiopathic pulmonary fibrosis and other ILDs compared with preMDD diagnosis (Harrell C-index, 0.666 vs 0.631; P = .08), which was particularly clear in patients with discordant MDD and preMDD diagnoses (hazard ratio, 2.68 vs 0.84; P = .012 vs .768). CONCLUSIONS: The MDD provided a definite diagnosis in 80.5% of presented cases, suggesting further investigations in almost all others. Given the high number of patients without preMDD diagnosis, the rate of change in preMDD diagnoses (41.9% of patients with a preMDD diagnosis) probably is an underestimation. The better prognostic discrimination among ILDs by using MDD indicates the added value of MDD in ILD.
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