Clinical impact of a multidisciplinary discussion group in the diagnosis of idiopathic pulmonary fibrosis in Colombia

Abstract

Introduction: Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease (ILD) with a poor prognosis, considered orphan in Colombia. A correct diagnosis has implications for the patient and the costs of care. Multidisciplinary Discussion Teams (MDT) are considered the gold standard in diagnosis. There are no previous studies in Colombia of the experience of an MDT.

Objectives: To evaluate the impact of a GDM in a 4th level institution in Bogotá in changing the diagnosis of patients with ILD and the concordance between the initial diagnosis and the final diagnosis of IPF.

Methods: Patients with ILD evaluated between 2015-2018 by the MDT made up of pneumologists, radiologist, pathologist and rheumatologists. ATS/ERS/JRS/ALAT criteria for IPF diagnosis. Description of the change in diagnosis and concordance between initial diagnosis and MDT in IPF.

Results: Of 165 patients with ILD, the diagnosis was changed in 35.2%. In 77.3% with an initial diagnosis of IPF and in 6.7% with an initial diagnosis other than IPF IPF was confirmed by MDT. Of the total, 64 (38.8%) patients had an IPF diagnosis from the MDT. When ruling out IPF, the main diagnoses were chronic hypersensitivity pneumonitis (29.4%) and non-specific interstitial pneumonia (23.5%). The kappa index between the initial and final IPF diagnosis was 0.71 (0.60-0.82).

Conclusions: MDT in ILD had an important clinical impact demonstrated by a high percentage of change in the diagnosis of remission. The initial diagnosis of IPF was ruled out in a significant percentage of patients and confirmed in a smaller group without this initial clinical suspicion