Department of Respiratory Medicine, Herlev and Gentofte Hospital, Kildegårdsvej 28, 2900, Hellerup, Denmark.
Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
Respir Res. 2019 May 24;20(1):103. doi: 10.1186/s12931-019-1076-0.
Surveys and retrospective studies of patients with idiopathic pulmonary fibrosis (IPF) have shown a significant diagnostic delay. However, the causes and risk factors for this delay are not known.
Dates at six time points before the IPF diagnosis (onset of symptoms, first contact to a general practitioner, first hospital contact, referral to an interstitial lung disease (ILD) centre, first visit at an ILD centre, and final diagnosis) were recorded in a multicentre cohort of 204 incident IPF patients. Based on these dates, the delay was divided into specific patient-related and healthcare-related delays. Demographic and clinical data were used to determine risk factors for a prolonged delay, using multivariate negative binomial regression analysis.
The median diagnostic delay was 2.1 years (IQR: 0.9-5.0), mainly attributable to the patients, general practitioners and community hospitals. Male sex was a risk factor for patient delay (IRR: 3.84, 95% CI: 1.17-11.36, p = 0.006) and old age was a risk factor for healthcare delay (IRR: 1.03, 95% CI: 1.01-1.06, p = 0.004). The total delay was prolonged in previous users of inhalation therapy (IRR: 1.99, 95% CI: 1.40-2.88, p < 0.0001) but not in patients with airway obstruction. Misdiagnosis of respiratory symptoms was reported by 41% of all patients.
Despite increased awareness of IPF, the diagnostic delay is still 2.1 years. Male sex, older age and treatment attempts for alternative diagnoses are risk factors for a delayed diagnosis of IPF. Efforts to reduce the diagnostic delay should focus on these risk factors.
This study was registered at http://clinicaltrials.gov (NCT02772549) on May 10, 2016.
对特发性肺纤维化 (IPF) 患者的调查和回顾性研究表明，存在显著的诊断延迟。然而，导致这种延迟的原因和危险因素尚不清楚。
在一个多中心队列的 204 例新发 IPF 患者中，记录了在 IPF 诊断（症状发作、首次就诊于全科医生、首次就诊于医院、转诊至间质性肺病 (ILD) 中心、首次就诊于ILD 中心和最终诊断）前的六个时间点的日期。根据这些日期，将延迟分为特定的患者相关和医疗保健相关的延迟。使用多变量负二项回归分析，根据人口统计学和临床数据，确定延长延迟的危险因素。
中位诊断延迟为 2.1 年（IQR：0.9-5.0），主要归因于患者、全科医生和社区医院。男性是患者延迟的危险因素（IRR：3.84，95%CI：1.17-11.36，p=0.006），而年龄较大是医疗保健延迟的危险因素（IRR：1.03，95%CI：1.01-1.06，p=0.004）。以前使用吸入疗法的患者总延迟时间延长（IRR：1.99，95%CI：1.40-2.88，p<0.0001），但无气道阻塞的患者则无此现象。所有患者中有 41%报告了呼吸道症状的误诊。
尽管对 IPF 的认识有所提高，但诊断延迟仍为 2.1 年。男性、年龄较大和尝试治疗其他诊断是 IPF 诊断延迟的危险因素。减少诊断延迟的努力应集中在这些危险因素上。
本研究于 2016 年 5 月 10 日在 http://clinicaltrials.gov（NCT02772549）注册。
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