Mehmet Hakan BILGIN, Ahmet ARISOY, Hanifi YILDIZ, Buket MERMIT, Selvi ASKAR
Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi - 2026;33(2):146-153
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 (kappa). 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 kappa = 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.
