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

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; 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

doi:10.1183/13993003.00936-2017

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

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 InoueMaria 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 (κ_w). 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 (κ_w=0.65, IQR 0.53–0.72, p<0.0001) than academic physicians (κ_w=0.56, IQR 0.45–0.65, p<0.0001) or physicians with access to multidisciplinary team (MDT) meetings (κ_w=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.

Original language	English
Article number	1700936
Number of pages	10
Journal	European Respiratory Journal
Volume	50
Issue number	2
DOIs	https://doi.org/10.1183/13993003.00936-2017
Publication status	Published - 31 Aug 2017

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Walsh, S. L. F., Maher, T. M., Kolb, M., Poletti, V., Nusser, R., Richeldi, L., Vancheri, C., Wilsher, M. L., Antoniou, K. M., Behr, J., Bendstrup, E., Brown, K., Calandriello, L., Corte, T. J., Cottin, V., Crestani, B., Flaherty, K., Glaspole, I., Grutters, J., ... Dhasmana, D. J. (2017). Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case-cohort study. European Respiratory Journal, 50(2), Article 1700936. https://doi.org/10.1183/13993003.00936-2017

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

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.",

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

note = "Copyright {\textcopyright}ERS 2017.",

year = "2017",

month = aug,

day = "31",

doi = "10.1183/13993003.00936-2017",

language = "English",

volume = "50",

journal = "European Respiratory Journal",

issn = "0903-1936",

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Walsh, SLF, Maher, TM, Kolb, M, Poletti, V, Nusser, R, Richeldi, L, Vancheri, C, Wilsher, ML, Antoniou, KM, Behr, J, Bendstrup, E, Brown, K, Calandriello, L, Corte, TJ, Cottin, V, Crestani, B, Flaherty, K, Glaspole, I, Grutters, J, Inoue, Y, Kokosi, M, Kondoh, Y, Kouranos, V, Kreuter, M, Johannson, K, Judge, E, Ley, B, Margaritopoulos, G, Martinez, FJ, Molina-Molina, M, Morais, A, Nunes, H, Raghu, G, Ryerson, CJ, Selman, M, Spagnolo, P, Taniguchi, H, Tomassetti, S, Valeyre, D, Wijsenbeek, M, Wuyts, W, Hansell, D, Wells, A, IPF Project Consortium & Dhasmana, DJ 2017, 'Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case-cohort study', European Respiratory Journal, vol. 50, no. 2, 1700936. https://doi.org/10.1183/13993003.00936-2017

TY - JOUR

T1 - Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis

T2 - an international case-cohort study

AU - Walsh, Simon L F

AU - Maher, Toby M

AU - Kolb, Martin

AU - Poletti, Venerino

AU - Nusser, Richard

AU - Richeldi, Luca

AU - Vancheri, Carlo

AU - Wilsher, Margaret L

AU - Antoniou, Katerina M

AU - Behr, Jüergen

AU - Bendstrup, Elisabeth

AU - Brown, Kevin

AU - Calandriello, Lucio

AU - Corte, Tamera J

AU - Cottin, Vincent

AU - Crestani, Bruno

AU - Flaherty, Kevin

AU - Glaspole, Ian

AU - Grutters, Jan

AU - Inoue, Yoshikazu

AU - Kokosi, Maria

AU - Kondoh, Yasuhiro

AU - Kouranos, Vasileios

AU - Kreuter, Michael

AU - Johannson, Kerri

AU - Judge, Eoin

AU - Ley, Brett

AU - Margaritopoulos, George

AU - Martinez, Fernando J

AU - Molina-Molina, Maria

AU - Morais, António

AU - Nunes, Hilario

AU - Raghu, Ganesh

AU - Ryerson, Christopher J

AU - Selman, Moises

AU - Spagnolo, Paolo

AU - Taniguchi, Hiroyuki

AU - Tomassetti, Sara

AU - Valeyre, Dominique

AU - Wijsenbeek, Marlies

AU - Wuyts, Wim

AU - Hansell, David

AU - Wells, Athol

AU - IPF Project Consortium

AU - Dhasmana, Devesh Janardan

PY - 2017/8/31

Y1 - 2017/8/31

N2 - 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.

AB - 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.

U2 - 10.1183/13993003.00936-2017

DO - 10.1183/13993003.00936-2017

M3 - Article

C2 - 28860269

SN - 0903-1936

VL - 50

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 2

M1 - 1700936

ER -

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

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