The impact of bronchoalveolar lavage cell analysis on clinicians' diagnostic reasoning about interstitial lung disease

J. K. Stoller, J. A. Rankin, H. Y. Reynolds

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

To assess the impact of bronchoalveolar lavage (BAL) on clinicians' diagnostic reasoning, we administered serial telephone questionnaires to all pulmonary physicians submitting BAL specimens to our laboratory from nonimmunocompromised patients with diffuse interstitial lung disease. Questionnaires were completed when the lavage specimens were first submitted and again after the results were reported to referring physicians. We recorded the clinicians' ordered list of likeliest diagnoses for the patient, a level of confidence in each diagnosis mentioned, and any proximate plans for further diagnostic tests. Of 78 patients in the study, information from the BAL fluid cell analysis caused clinicians to change their diagnostic thinking in 46 (59 percent). These changes were far more frequently appropriate (52 percent) than not (9 percent), and clinically impressive changes did occur but were infrequent (3 of 78 [4 percent]) in this series. Specifically, BAL permitted the unexpected diagnosis of Pneumocystic carinii in a patient not previously suspected to have acquired immune deficiency syndrome (AIDS) and appropriately encouraged clinicians to avert planned surgical biopsies in two patients subsequently found to have sarcoidosis. These findings suggest that when used to evaluate nonimmunocompromised patients, BAL fluid cell analysis can have an important impact on clinicians' diagnostic reasoning about their patients' interstitial lung diseases.

Original languageEnglish (US)
Pages (from-to)839-843
Number of pages5
JournalCHEST
Volume92
Issue number5
StatePublished - Dec 1 1987

Fingerprint

Interstitial Lung Diseases
Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid
Physicians
Therapeutic Irrigation
Sarcoidosis
Routine Diagnostic Tests
Telephone
Acquired Immunodeficiency Syndrome
Biopsy
Lung

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Stoller, J. K. ; Rankin, J. A. ; Reynolds, H. Y. / The impact of bronchoalveolar lavage cell analysis on clinicians' diagnostic reasoning about interstitial lung disease. In: CHEST. 1987 ; Vol. 92, No. 5. pp. 839-843.
@article{c99f3576e3d249c28a2baafc7cc89bac,
title = "The impact of bronchoalveolar lavage cell analysis on clinicians' diagnostic reasoning about interstitial lung disease",
abstract = "To assess the impact of bronchoalveolar lavage (BAL) on clinicians' diagnostic reasoning, we administered serial telephone questionnaires to all pulmonary physicians submitting BAL specimens to our laboratory from nonimmunocompromised patients with diffuse interstitial lung disease. Questionnaires were completed when the lavage specimens were first submitted and again after the results were reported to referring physicians. We recorded the clinicians' ordered list of likeliest diagnoses for the patient, a level of confidence in each diagnosis mentioned, and any proximate plans for further diagnostic tests. Of 78 patients in the study, information from the BAL fluid cell analysis caused clinicians to change their diagnostic thinking in 46 (59 percent). These changes were far more frequently appropriate (52 percent) than not (9 percent), and clinically impressive changes did occur but were infrequent (3 of 78 [4 percent]) in this series. Specifically, BAL permitted the unexpected diagnosis of Pneumocystic carinii in a patient not previously suspected to have acquired immune deficiency syndrome (AIDS) and appropriately encouraged clinicians to avert planned surgical biopsies in two patients subsequently found to have sarcoidosis. These findings suggest that when used to evaluate nonimmunocompromised patients, BAL fluid cell analysis can have an important impact on clinicians' diagnostic reasoning about their patients' interstitial lung diseases.",
author = "Stoller, {J. K.} and Rankin, {J. A.} and Reynolds, {H. Y.}",
year = "1987",
month = "12",
day = "1",
language = "English (US)",
volume = "92",
pages = "839--843",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "5",

}

The impact of bronchoalveolar lavage cell analysis on clinicians' diagnostic reasoning about interstitial lung disease. / Stoller, J. K.; Rankin, J. A.; Reynolds, H. Y.

In: CHEST, Vol. 92, No. 5, 01.12.1987, p. 839-843.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact of bronchoalveolar lavage cell analysis on clinicians' diagnostic reasoning about interstitial lung disease

AU - Stoller, J. K.

AU - Rankin, J. A.

AU - Reynolds, H. Y.

PY - 1987/12/1

Y1 - 1987/12/1

N2 - To assess the impact of bronchoalveolar lavage (BAL) on clinicians' diagnostic reasoning, we administered serial telephone questionnaires to all pulmonary physicians submitting BAL specimens to our laboratory from nonimmunocompromised patients with diffuse interstitial lung disease. Questionnaires were completed when the lavage specimens were first submitted and again after the results were reported to referring physicians. We recorded the clinicians' ordered list of likeliest diagnoses for the patient, a level of confidence in each diagnosis mentioned, and any proximate plans for further diagnostic tests. Of 78 patients in the study, information from the BAL fluid cell analysis caused clinicians to change their diagnostic thinking in 46 (59 percent). These changes were far more frequently appropriate (52 percent) than not (9 percent), and clinically impressive changes did occur but were infrequent (3 of 78 [4 percent]) in this series. Specifically, BAL permitted the unexpected diagnosis of Pneumocystic carinii in a patient not previously suspected to have acquired immune deficiency syndrome (AIDS) and appropriately encouraged clinicians to avert planned surgical biopsies in two patients subsequently found to have sarcoidosis. These findings suggest that when used to evaluate nonimmunocompromised patients, BAL fluid cell analysis can have an important impact on clinicians' diagnostic reasoning about their patients' interstitial lung diseases.

AB - To assess the impact of bronchoalveolar lavage (BAL) on clinicians' diagnostic reasoning, we administered serial telephone questionnaires to all pulmonary physicians submitting BAL specimens to our laboratory from nonimmunocompromised patients with diffuse interstitial lung disease. Questionnaires were completed when the lavage specimens were first submitted and again after the results were reported to referring physicians. We recorded the clinicians' ordered list of likeliest diagnoses for the patient, a level of confidence in each diagnosis mentioned, and any proximate plans for further diagnostic tests. Of 78 patients in the study, information from the BAL fluid cell analysis caused clinicians to change their diagnostic thinking in 46 (59 percent). These changes were far more frequently appropriate (52 percent) than not (9 percent), and clinically impressive changes did occur but were infrequent (3 of 78 [4 percent]) in this series. Specifically, BAL permitted the unexpected diagnosis of Pneumocystic carinii in a patient not previously suspected to have acquired immune deficiency syndrome (AIDS) and appropriately encouraged clinicians to avert planned surgical biopsies in two patients subsequently found to have sarcoidosis. These findings suggest that when used to evaluate nonimmunocompromised patients, BAL fluid cell analysis can have an important impact on clinicians' diagnostic reasoning about their patients' interstitial lung diseases.

UR - http://www.scopus.com/inward/record.url?scp=0023499729&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0023499729&partnerID=8YFLogxK

M3 - Article

C2 - 3665598

AN - SCOPUS:0023499729

VL - 92

SP - 839

EP - 843

JO - Chest

JF - Chest

SN - 0012-3692

IS - 5

ER -