WCLC 2025 - Posters & ePosters-EP.17.14 Concordance Between Clinical and Radiological Diagnoses of Pneumonitis: Retrospective Cohort Review From Regional Health Service in Australia

EP.17.14 Concordance Between Clinical and Radiological Diagnoses of Pneumonitis: Retrospective Cohort Review From Regional Health Service in Australia

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This retrospective cohort study by Dr. Divyanshu Dua from Central Gippsland Health, Australia, investigates concordance between clinical and radiological diagnoses of pneumonitis in emergency department (ED) presentations from July 2023 to June 2025. Pneumonitis lacks a specific ICD-10-AM code, with J69.0 (aspiration pneumonia) and J70.9 (respiratory condition due to external agent) used as proxies in coding. Automated coding alone may misclassify cases, notably affecting oncology patients, where pneumonitis is a known toxicity of immune checkpoint inhibitors (ICIs), antibody-drug conjugates, and thoracic radiotherapy.<br /><br />The study reviewed 19 cases from ED records coded with J69.0 or J70.9, excluding 4 cases (smoke inhalation and pediatric), yielding 15 adult patients with a mean age of 66.4 years and male predominance. Radiological findings included consolidation (2 cases), normal imaging (2), and pneumonitis-consistent changes (11). Strong concordance between clinical suspicion and radiological findings was documented, though discrepancies existed mainly with consolidation and normal imaging, where clinical suspicion was maintained.<br /><br />Findings highlight that ICD coding alone is insufficient to identify pneumonitis accurately. Combining clinical assessment and radiological review, especially in resource-limited or rural ED settings where CT scans are not always available, improves diagnostic accuracy and supports timely corticosteroid treatment to avoid respiratory failure. This is critical in oncology care, as ICI-related pneumonitis incidence ranges from 3% to 19%, with real-world data showing up to 35% of ICI-related deaths attributable to pneumonitis.<br /><br />The study’s limitations include its single-center design and small sample size, but it underscores the importance of manual case review alongside clinical and radiological evaluation. Early recognition of pneumonitis in ED facilitates safer administration of immunotherapy and other advanced cancer treatments, reducing mortality and treatment delays.

Asset Subtitle

Divyanshu Dua

Meta Tag

Speaker Divyanshu Dua

Topic Global Health, Health Services, and Health Economics

Keywords

pneumonitis

ICD-10-AM coding

clinical-radiological concordance

emergency department

immune checkpoint inhibitors

aspiration pneumonia

oncology toxicity

radiological diagnosis

corticosteroid treatment

diagnostic accuracy