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The Impact of Multidisciplinary Discussion (MDD) in the Diagnosis and Management of Fibrotic Interstitial Lung Diseases.
Canadian Respiratory Journal ( IF 2.2 ) Pub Date : 2020-08-17 , DOI: 10.1155/2020/9026171
Ghofran Ageely 1, 2 , Carolina Souza 1 , Kaissa De Boer 3, 4 , Saly Zahra 1 , Marcio Gomes 5 , Nha Voduc 3
Affiliation  

Accurate diagnosis of interstitial lung disease (ILD) is crucial for management and prognosis but can be challenging even for experienced clinicians. Expert multidisciplinary discussion (MDD) is considered the reference standard for ILD diagnosis; however, there remain concerns regarding lack of validation studies and relative limited information on the impact of MDD in real-life clinical practice. The goal of this study was to assess the effect of MDD in providing a specific ILD diagnosis, changing the diagnosis provided upon referral, and to determine how often and in which way MDD altered management. Material and Methods. Retrospective observational study in an ILD referral tertiary academic center. MDD diagnoses were categorized as specific, provisional, and unclassifiable ILD. Pre-MDD and MDD diagnoses were compared for change in diagnosis and concordance rates for specific diagnoses. Relevant change in management including initiation or change in pharmacological treatment, referral to surgical biopsy, and nonpharmacological management were recorded. Results. 126 cases were included (79M, 47F, 36–93 years, mean 70 y). Specific MDD diagnosis was provided in 62% (78/126); 12% (15/126) had provisional diagnosis, and 21% (27/126) was unclassifiable. Overall agreement for specific pre-MDD and MDD diagnosis was 41% (52/126) and 80% for idiopathic pulmonary fibrosis (IPF) diagnosis. MDD altered diagnosis in 37% (47/126) and changed management in 39% (50/126). Amongst concordant diagnoses, management was altered in 46% (24/52). In summary, MDD provided a specific diagnosis discordant with pre-MDD diagnosis in a significant proportion of cases and was particularly valuable in the diagnosis of non-IPF ILD. MDD often altered management and had relevant impact on management even in cases with concordant pre-MDD diagnosis.

中文翻译:

多学科讨论 (MDD) 在纤维化间质性肺病诊断和管理中的影响。

间质性肺病 (ILD) 的准确诊断对于治疗和预后至关重要,但即使对有经验的临床医生也具有挑战性。专家多学科讨论(MDD)被认为是 ILD 诊断的参考标准;然而,仍然存在关于缺乏验证研究和关于 MDD 在现实临床实践中影响的信息相对有限的担忧。本研究的目的是评估 MDD 在提供特定 ILD 诊断、改变转诊时提供的诊断方面的影响,并确定 MDD 改变管理的频率和方式。材料与方法. 在 ILD 转诊三级学术中心进行的回顾性观察研究。MDD 诊断被分类为特定的、临时的和不可分类的 ILD。比较前 MDD 和 MDD 诊断的诊断变化和特定诊断的符合率。记录管理的相关变化,包括开始或改变药物治疗、转诊至手术活检和非药物管理。结果. 包括 126 例(79M,47F,36-93 岁,平均 70 岁)。62% (78/126) 提供特定 MDD 诊断;12% (15/126) 有临时诊断,21% (27/126) 无法分类。特定 MDD 前和 MDD 诊断的总体一致性为 41% (52/126),特发性肺纤维化 (IPF) 诊断的总体一致性为 80%。MDD 改变了 37% (47/126) 的诊断,改变了 39% (50/126) 的管理。在一致的诊断中,46% (24/52) 的管理发生了改变。总之,MDD 在很大比例的病例中提供了与 MDD 前诊断不一致的特定诊断,并且在非 IPF ILD 的诊断中特别有价值。MDD 经常改变管理并对管理产生相关影响,即使在 MDD 前诊断一致的情况下也是如此。
更新日期:2020-08-17
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