Idiopathic interstitial pneumonia: do community and academic physicians agree on diagnosis?
BACKGROUND
Treatment and prognoses of diffuse parenchymal lung diseases (DPLDs) varies by diagnosis. Obtaining a uniform diagnosis among observers is difficult.


OBJECTIVE
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.


RESULTS
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. 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 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.
Flaherty
Kevin R
KR
University of Michigan Health System, Ann Arbor, MI 48109-0360, USA. flaherty@umich.edu
Andrei
Adin-Cristian
AC
King
Talmadge E
TE
Raghu
Ganesh
G
Colby
Thomas V
TV
Wells
Athol
A
Bassily
Nadir
N
Brown
Kevin
K
du Bois
Roland
R
Flint
Andrew
A
Gay
Steven E
SE
Gross
Barry H
BH
Kazerooni
Ella A
EA
Knapp
Robert
R
Louvar
Edmund
E
Lynch
David
D
Nicholson
Andrew G
AG
Quick
John
J
Thannickal
Victor J
VJ
Travis
William D
WD
Vyskocil
James
J
Wadenstorer
Frazer A
FA
Wilt
Jeffrey
J
Toews
Galen B
GB
Murray
Susan
S
Martinez
Fernando J
FJ
D000046:Academic Medical Centers; D003154:Community Medicine; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000473:pathology; D010820:Physicians; D011379:Prognosis