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Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case-cohort study

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Simon L F Walsh, Toby M Maher, Martin Kolb, Venerino Poletti, Richard Nusser, Luca Richeldi, Carlo Vancheri, Margaret L Wilsher, Katerina M Antoniou, Jüergen Behr, Elisabeth Bendstrup, Kevin Brown, Lucio Calandriello, Tamera J Corte, Vincent Cottin, Bruno Crestani, Kevin Flaherty, Ian Glaspole, Jan Grutters, Yoshikazu Inoue & 25 others Maria Kokosi, Yasuhiro Kondoh, Vasileios Kouranos, Michael Kreuter, Kerri Johannson, Eoin Judge, Brett Ley, George Margaritopoulos, Fernando J Martinez, Maria Molina-Molina, António Morais, Hilario Nunes, Ganesh Raghu, Christopher J Ryerson, Moises Selman, Paolo Spagnolo, Hiroyuki Taniguchi, Sara Tomassetti, Dominique Valeyre, Marlies Wijsenbeek, Wim Wuyts, David Hansell, Athol Wells, IPF Project Consortium, Devesh Janardan Dhasmana

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Abstract

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts.

A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (κw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the C-index.

A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (κw=0.65, IQR 0.53–0.72, p<0.0001) than academic physicians (κw=0.56, IQR 0.45–0.65, p<0.0001) or physicians with access to multidisciplinary team (MDT) meetings (κw=0.54, IQR 0.45–0.64, p<0.0001). The prognostic accuracy of academic physicians with >20 years of experience (C-index=0.72, IQR 0.0–0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70–0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72–0.75).

Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts.

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Original languageEnglish
Article number1700936
Number of pages10
JournalEuropean Respiratory Journal
Volume50
Issue number2
DOIs
StatePublished - 31 Aug 2017

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