0
Clinical Investigations: SARCOIDOSIS |

The Diagnostic Pathway to Sarcoidosis*

Marc A. Judson, MD, FCCP; Bruce W. Thompson, PhD; David L. Rabin, MD, MPH; Joanne Steimel, RN, BSN; Genell L. Knattereud, PhD; Daniel T. Lackland, DrPH; Cecile Rose, MD, MPH; Cynthia S. Rand, PhD; Robert P. Baughman, MD, FCCP; Alvin S. Teirstein, MD, FCCP; for the ACCESS Research Group
Author and Funding Information

Affiliations: *From the Division of Pulmonary and Critical Care Medicine (Dr. Judson) and Department of Biometry and Epidemiology (Dr. Lackland), Medical University of South Carolina, Charleston, SC; Clinical Trials and Surveys Corporation (Drs. Thompson and Knattereud), Baltimore, MD; Division of Community Health Care Studies (Dr. Rabin), Georgetown University Medical Center, Washington, DC; Division of Pulmonary and Critical Care Medicine (Drs. Steimel and Rand), Johns Hopkins Medical Center, Baltimore, MD; Division of Occupational Medicine Division (Dr. Rose), National Jewish Medical and Research Center and University of Colorado Health Sciences Center, Denver, CO; Department of Internal Medicine (Dr. Baughman), Division of Pulmonary and Critical Care Medicine (Dr. Teirstein), Mount Sinai Medical Center, New York, NY.,  Participants are listed in the Appendix.

Correspondence to: Marc A. Judson, MD, FCCP, Associate Professor, Division of Pulmonary and Critical Care Medicine, 96 Jonathan Lucas St, Charleston, SC 29425; e-mail: judsonma@MUSC.edu


Affiliations: *From the Division of Pulmonary and Critical Care Medicine (Dr. Judson) and Department of Biometry and Epidemiology (Dr. Lackland), Medical University of South Carolina, Charleston, SC; Clinical Trials and Surveys Corporation (Drs. Thompson and Knattereud), Baltimore, MD; Division of Community Health Care Studies (Dr. Rabin), Georgetown University Medical Center, Washington, DC; Division of Pulmonary and Critical Care Medicine (Drs. Steimel and Rand), Johns Hopkins Medical Center, Baltimore, MD; Division of Occupational Medicine Division (Dr. Rose), National Jewish Medical and Research Center and University of Colorado Health Sciences Center, Denver, CO; Department of Internal Medicine (Dr. Baughman), Division of Pulmonary and Critical Care Medicine (Dr. Teirstein), Mount Sinai Medical Center, New York, NY.,  Participants are listed in the Appendix.


Chest. 2003;123(2):406-412. doi:10.1378/chest.123.2.406
Text Size: A A A
Published online

Purpose: To examine the time from the first physician visit to the diagnosis of sarcoidosis.

Hypotheses: The time required to diagnose sarcoidosis is dependent on the initial symptoms, socioeconomic status, referral to a specialist, race, and severity of pulmonary involvement.

Methods: Patients were recruited from the Case Control Etiology of Sarcoidosis Study (ACCESS) and had biopsy-confirmed sarcoidosis. Subjects were asked to recall the date of onset of symptoms of sarcoidosis, their first physician visit, number of physician visits, and types of physicians seen.

Results: One hundred eighty-nine patients were enrolled. The diagnosis of sarcoidosis was made on the first physician visit in only 15.3% of cases. The presence of pulmonary symptoms was associated with prolonged time (> 6 months vs ≤ 6 months, p = 0.02) until diagnosis, and the presence of skin symptoms with a shorter time (≤ 6 months vs > 6 months, p = 0.02) until diagnosis. Patients with pulmonary symptoms had more physician visits (mean ± SEM) until the diagnosis was made compared to those without pulmonary symptoms (4.84 ± 0.38 visits vs 3.15 ± 0.24 visits, p = 0.0002). The mean baseline FEV1 was greater in those diagnosed ≤ 6 months from the first physician visit than those diagnosed > 6 months (87.3 ± 1.52% predicted vs 81.2 ± 2.5% predicted, p = 0.04). There was a significant delay in diagnosis (> 6 months vs ≤ 6 months) from first physician visit with higher Scadding stages (stage 4 vs stage 2, or stage 3 vs stage 0 or 1, p = 0.04).

Conclusions: The diagnosis of sarcoidosis is often delayed and seems to be more a factor of disease presentation than patient or physician characteristics. The presence of pulmonary symptoms or higher radiographic stages is associated with a prolonged time until diagnosis. The presence of skin symptoms is associated with less delay in diagnosis. It is likely that the delay in diagnosis of pulmonary sarcoidosis relates to the fact that pulmonary symptoms and parenchymal involvement are nonspecific and are often regarded as manifestations of other pulmonary diseases.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Topics

sarcoidosis

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543