Published ahead of print on January 25, 2007, doi:10.1164/rccm.200606-833OC
Am. J. Respir. Crit. Care Med., Volume 175, Number 10, May 2007, 1054-1060
A more recent version of this article appeared on May 15, 2007
Submitted on June 22, 2006
Accepted on January 25, 2007
Idiopathic Interstitial Pneumonia: Do Community and Academic Physicians Agree on Diagnosis?
Kevin R Flaherty1*, Adin-Cristian Andrei2, Talmadge E King Jr.3, Ganesh Raghu4, Thomas V Colby5, Athol Wells6, Nadir Bassily7, Kevin K Brown8, Roland du Bois6, Andrew Flint9, Steven E Gay1, Barry H Gross10, Ella A Kazerooni10, Robert Knapp11, Edmund Louvar7, David Lynch8, Andrew G Nicholson6, John Quick7, Victor Thannickal1, and William D Travis12
1 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA,
2 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA,
3 University of California, San Francisco, CA, USA,
4 University of Washington, Seattle, WA, USA,
5 Mayo Clinic, Scottsdale, AZ, USA,
6 Royal Brompton Hospital, London, United Kingdom,
7 McLaren Regional Medical Center, Flint, MI, USA,
8 National Jewish Medical Center, Denver, CO, USA,
9 Department of Pathology, University of Michigan Health System, Ann Arbor, MI, USA,
10 Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA,
11 Spectrum Health System, Grand Rapids, MI, USA,
12 Memorial Sloan Kettering Cancer Center, New York, NY, USA
* To whom correspondence should be addressed. E-mail: flaherty{at}umich.edu.
Rationale: Treatment and prognoses of diffuse parenchymal lung diseases varies by diagnosis. Obtaining a uniform diagnosis among observers is difficult.
Objective: Evaluate diagnostic agreement between academic and community based physicians for patients with diffuse parenchymal lung diseases. 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 diffuse parenchymal lung disease. Nineteen participants reviewed cases at two community locations and one 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: Each observer's diagnosis was coded into one of eight categories. A kappa statistic allowing for multiple raters was used to assess agreement in diagnosis.
Results: Interactions between clinicians, radiologists, and pathologists improved interobserver agreement at both community and academic sites, however final agreement was better within academic centers (kappa 0.55-0.71) than within community centers (kappa 0.32-0.44). Clinically significant disagreement was present between academic and community based physicians (kappa 0.11-0.56). Community physicians were more likely to assign a final diagnosis of idiopathic pulmonary fibrosis compared to academic physicians.
Conclusion: Significant disagreement exists in the diagnosis of diffuse parenchymal lung disease between physicians based in community compared to academic centers. Whenever 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.
Key words: usual interstitial pneumonia, nonspecific interstitial pneumonia, diagnosis, community, academic
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