Diagnostic Ability of a Dynamic Multidisciplinary Discussion in Interstitial Lung Diseases A Retrospective Observational Study of 938 Cases
Diagnostic Ability of a Dynamic Multidisciplinary Discussion in Interstitial Lung Diseases A Retrospective Observational Study of 938 Cases
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DOI：
10.1016/j.chest.2018.03.026
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发表时间：
2018-06-01
期刊：
影响因子：
9.6
通讯作者：
Wuyts, Wim A.
中科院分区：
文献类型：
--
作者：
De Sadeleer, Laurens J.;Meert, Caressa;Wuyts, Wim A.
背景技术背景：动态多学科讨论（MDD）的建议被认为是重要的间质性肺疾病（ILD）的诊断。然而，MDD诊断在多大程度上不同于正式检查前的初步诊断，MDD（preMDD diagnosis）仍缺乏充分的研究。方法：我们比较了2005年1月至2015年12月在鲁汶大学医院MDDs讨论的患者的preMDD和MDD诊断。结果：在MDD讨论的938例连续患者中，755例（80.5%）接受了特定诊断。在183例无法分类的ILD患者中，150例患者（16.0%）收到了关于进一步检查以确定明确诊断的建议。在191例患者（41.9%的MDD前诊断患者）中，MDD改变了诊断。在384例患者中（79.5%的患者未进行MDD前诊断），当转诊医生未进行诊断时，MDD提供了诊断。与MDD前诊断相比，MDD诊断在特发性肺纤维化和其他ILD之间显示出更好的预后区分趋势（Harrell C指数，0.666 vs 0.631; P = 0.08），这在MDD和preMDD诊断不一致的患者中尤其明显结论：MDD在80.5%的病例中提供了明确的诊断，提示对几乎所有其他病例进行进一步的调查。鉴于大量患者未被诊断为preMDD，preMDD诊断的变化率（41.9%的preMDD诊断患者）可能被低估。MDD在ILD中的更好的预后区分表明MDD在ILD中的附加价值。
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.