Clinical Profile and In-Hospital Distribution of Pulmonology Consultations: A Tertiary University Hospital Experience

Abstract

Objective Pulmonology consultations play a vital role in in-hospital diagnostic and therapeutic processes. These consultations are requested for various clinical reasons, including respiratory symptoms, radiological findings, and preoperative evaluations, which directly impact the quality of patient care. Material and Method This retrospective analysis evaluated 23,000 consultation records (11,500 unique patients). Diagnostic concordance was defined as the agreement between the preliminary diagnosis (requesting physician) and the final diagnosis (pulmonologist), calculated using Cohen’s kappa (κ). Consultation response times were extracted from the hospital's electronic health record (Enlil HBYS) timestamps. Results The emergency department was the predominant consultation source (32.4%). Preliminary diagnoses focused on dyspnea (12.5%), cough (10.0%), and chest pain (8.0%), while final diagnoses revealed COPD (Chronic Obstructive Pulmonary Disease) (13.8%), pulmonary embolism (11.0%), and pneumonia (9.4%) as the leading conditions. Diagnostic concordance was low (12.3%; Cohen’s κ = 0.15), with mean response times of 160 minutes (median: 145; IQR: 90–210). Among the 11,500 unique patients, 9,614 (83.6%) were preoperative consultations. The majority involved males (57.9%) aged 18–70 years (with 49.2% in the 51–70 group), demonstrating significantly reduced postoperative pulmonary complications versus non-consulted cases (8.7% vs. 14.2%, p =0.011). Conclusion While emergency departments drive most pulmonary consultations with frequent serious diagnoses (COPD/pulmonary embolism), low diagnostic concordance underscores the need for improved evaluation protocols. The demonstrated 38.7% relative risk reduction in postoperative complications (NNT = 18) strongly supports mandatory preoperative pulmonary assessments for high-risk surgical populations.

Keywords

• Referral and Consultation
• Pulmonary Medicine
• Postoperative Complications
• Tertiary Care Centers
• Perioperative Medicine
• Pulmonary Disease
• Chronic Obstructive
• Pneumonia

Supporting Institution

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.

Project Number

Not applicable

Ethical Statement

Ethical Approval This study was reviewed and approved by the Non-Interventional Clinical Research Ethics Committee of Van Yuzuncu Yil University Faculty of Medicine on 28/02/2025 (Approval No: 2025/02-05). All data were retrospectively obtained through the hospital’s information management system in an anonymized format, with full adherence to data protection regulations. All procedures involving human participants complied with the ethical standards of the institutional research committee and the 1964 Declaration of Helsinki and its later amendments. Consent to Participate and Publish Since the study was based on retrospective data without the use of identifiable personal information, informed consent was not required.

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