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

Walsh, Simon L.F.; Maher, Toby M.; Kolb, Martin; Poletti, Venerino; Nusser, Richard; Richeldi, Luca; Vancheri, Carlo; Wilsher, Margaret L.; Antoniou, Katerina M.; Behr, Jüergen; Bendstrup, Elisabeth; Brown, Kevin; Calandriello, Lucio; Corte, Tamera J.; Cottin, Vincent; Crestani, Bruno; Flaherty, Kevin; Glaspole, Ian; Grutters, Jan; Inoue, Yoshikazu; Kokosi, Maria; Kondoh, Yasuhiro; Kouranos, Vasileios; Kreuter, Michael; Johannson, Kerri; Judge, Eoin; Ley, Brett; Margaritopoulos, George; Martinez, Fernando J.; Molina-Molina, Maria; Morais, António; Nunes, Hilario; Raghu, Ganesh; Ryerson, Christopher J.; Selman, Moises; Spagnolo, Paolo; Taniguchi, Hiroyuki; Tomassetti, Sara; Valeyre, Dominique; Wijsenbeek, Marlies; Wuyts, Wim; Hansell, David; Wells, Athol


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



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 less than 0.0001) or physicians with access to multidisciplinary team (MDT) meetings (κw=0.54, IQR 0.45–0.64, p less than 0.0001). The prognostic accuracy of academic physicians with greater than 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.


Walsh, S. L., Maher, T. M., Kolb, M., Poletti, V., Nusser, R., Richeldi, L., …Wells, A. (2017). Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study. European respiratory journal, 50(2), Article 1700936.

Journal Article Type Article
Acceptance Date May 30, 2017
Online Publication Date Aug 31, 2017
Publication Date Aug 31, 2017
Deposit Date Jul 9, 2018
Publicly Available Date Oct 27, 2022
Journal European Respiratory Journal
Print ISSN 0903-1936
Electronic ISSN 1399-3003
Publisher European Respiratory Society
Peer Reviewed Peer Reviewed
Volume 50
Issue 2
Article Number 1700936
Public URL
Publisher URL
Related Public URLs
Additional Information This is the accepted manuscript of an article published in European respiratory journal, 2017. The version of record is available at the DOI link in this record.


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