Background

While pulmonary nodule guidelines provide follow-up recommendations based on nodule size and malignancy risk, these are inconsistently followed in clinical practice. In this study, we sought to identify patient characteristics associated with guideline-concordant nodule follow-up.

Methods

We conducted a retrospective cohort study of patients diagnosed with a pulmonary nodule between 2011 and 2014 at Boston Medical Center. Appropriate nodule follow-up evaluation was based upon the 2005 Fleischner Society Guidelines. In primary analysis, we compared patients with guideline-concordant follow-up to those with delayed or absent follow-up. In secondary analysis, we compared those with any follow-up to those without follow-up as well as the rate of guideline-concordant follow-up in patients seen by a pulmonologist.

Results

Of 3916 patients diagnosed with a pulmonary nodule, 1117 were included for analysis. Overall, 598 (53.5%) patients received guideline-concordant follow-up. Lower rates of guideline concordance were seen in patients of Hispanic ethnicity (OR 0.60, 95% CI 0.36–1.00), while higher rates were seen for nodules 7–8 mm (OR 1.55, 95% CI 1.02–2.35) and nodules >8 mm (OR 1.49, 95% CI 1.01–2.20). Having a history of COPD (OR 1.75, 95% CI 1.26–2.43), and being seen by a pulmonologist (OR 1.97, 95% CI 1.51–2.58) were also associated with guideline concordance. Among patients seen by a pulmonologist, 62.2% received guideline-concordant follow-up.

Conclusion

Overall rates of pulmonary nodule follow-up are low. Patient ethnicity, COPD history, nodule size and involvement of a pulmonologist may impact follow-up rates and are potential targets for implementation interventions to improve pulmonary nodule follow-up.

中文翻译：

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遵守肺结节指南的患者特征。

背景

尽管肺结节指南根据结节大小和恶性风险提供了后续建议，但在临床实践中始终遵循这些建议。在这项研究中，我们试图确定与指南一致结节随访相关的患者特征。

方法

我们对波士顿医学中心2011年至2014年之间诊断为肺结节的患者进行了回顾性队列研究。适当的结节随访评估基于《 2005年弗莱什纳学会指南》。在初步分析中，我们将遵循指南一致性随访的患者与延迟或缺乏随访的患者进行了比较。在二级分析中，我们比较了有任何随访的患者和没有随访的患者，以及肺科医师所见患者的指南一致随访率。

结果

在3916名被诊断患有肺结节的患者中，包括1117名患者进行了分析。总体上，有598例（53.5％）患者接受了指南一致的随访。西班牙裔患者指南一致性较低（OR 0.60，95％CI 0.36–1.00），结节7–8 mm（OR 1.55，95％CI 1.02–2.35）和结节> 8毫米（或1.49，95％CI 1.01-2.20）。具有COPD病史（OR 1.75，95％CI 1.26–2.43）并被肺科医师看病（OR 1.97，95％CI 1.51–2.58）也与指南一致性相关。在肺科医师看过的患者中，有62.2％接受了指南一致的随访。

结论

肺结节随访的总体发生率较低。患者种族，COPD病史，结节大小和肺科医师的参与可能会影响随访率，并且可能是实施干预措施以改善肺结节随访的潜在目标。