Introduction Accurate diagnosis in Interstitial Lung Disease (ILD) is vital in optimising patient management. An integrated approach involving a multidisciplinary team (MDT) of physicians, radiologists and pathologists is strongly advised in ATS/ERS guidelines.1 This has been shown to improve diagnostic confidence.2 Consensus diagnosis post multidisciplinary team discussion often differs from that reached by individual clinicians. Our centre, which provides a tertiary interstitial lung disease service in the North of England, implemented multidisciplinary discussion in 2005. Our patient cohort is larger than series previously presented at both national and international respiratory meetings. Literature search also did not identify any published data with either an equal or greater patient population.
Aims To review interstitial lung disease MDT outcomes and to determine if discussion resulted in a change of diagnosis and whether this impacted on subsequent patient management.
Methods Retrospective review of both patient clinical notes and MDT outcomes from 2005 to 2013 was performed. Data from 2009 and 2010 was unavailable as it was not stored electronically.
Results 385 patients were referred for MDT review from 2005 to 2008 (n = 167) and 2011 to 2013 (n = 218). Usual Interstitial Pneumonia (UIP) was the pre-MDT diagnosis in 144 (37%) cases. Post-MDT 71 (49%) individuals had their diagnosis altered, leading to a change of treatment in 37 (52%) cases. A further 3 patients were referred for biopsy. One individual died pre-MDT and therefore was not discussed.
Of the 68 cases referred with no diagnosis multidisciplinary consensus was reached in 60 (88%) cases. The remaining 172 were referred with a range of aetiologies.
Conclusion Our findings support ARS/ERS consensus guidelines1 which strongly advise the implementation of multidisciplinary discussion in the care of the individual with interstitial lung disease.
Flaherty K et al. Am J Crit Care Med Vol 170. pp904–910, 2004
Raghu G et al. Am J Crit Care Med Vol 183. pp788–824, 2011