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Canadian Respiratory Journal
Volume 22, Issue 2, Pages 86-90
Original Article

Diagnostic Disparity of Previous and Revised American Thoracic Society Guidelines for Idiopathic Pulmonary Fibrosis

Lee Fidler,1 Shane Shapera,2,3 Shikha Mittoo,4,5 and Theodore K Marras2,3

1Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada
2Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Canada
3Division of Respirology, Department of Medicine, University of Toronto, Canada
4Division of Rheumatology, Department of Medicine, Mount Sinai Hospital and University Health Network, Canada
5Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: A revised guideline for the diagnosis of idiopathic pulmonary fibrosis (IPF) was formulated by the American Thoracic Society (ATS) in 2011 to improve disease diagnosis and provide a simplified algorithm for clinicians. The impact of these revisions on patient classification, however, remain unclear.

OBJECTIVE: To examine the concordance between diagnostic guidelines to understand how revisions impact patient classification.

METHODS: A cohort of 54 patients with either suspected IPF or a working diagnosis of IPF was evaluated in a retrospective chart review, in which patient data were examined according to previous and revised ATS guidelines. Patient characteristics influencing the fulfillment of diagnostic criteria were compared using one-way ANOVA and χ2 tests.

RESULTS: Revised and previous guideline criteria for IPF were met in 78% and 83% of patients, respectively. Revised guidelines modified a classification based on previous guidelines in 28% of cases. Fifteen percent of patients meeting previous ATS guidelines failed to meet revised criteria due to a lack of honeycombing on high-resolution computed tomography and the absence of a surgical lung biopsy. Patients failing to meet previous and revised diagnostic criteria for IPF were younger.

CONCLUSION: The revised guidelines for the diagnosis of IPF classify a substantial proportion of patients differently than the previous guidelines.