An Audit on the Screening of Biopsy Confirmed Sarcoidosis in a University Hospital

Abstract

Early detection of asymptomatic extrapulmonary disease can reduce complications in sarcoid. This retrospective audit examined screening practices in biopsy proven pulmonary sarcoidosis to assess adherence to ATS guidelines for extra-pulmonary screening. Patients were selected from HIPE coding with diagnosis of sarcoidosis cross-referenced with biopsy procedures. We used our electronic system to review practices. As per guidelines, screening should consist of an ocular exam, renal profile, bone profile, full blood count and ECG. Cardiac MRI should be undertaken if cardiac involvement is suspected and TTE if pulmonary hypertension is suspected. We assessed if ACE levels were ordered as there is no consensus on this. Over 5 years, 69 patients were diagnosed with biopsy proven sarcoidosis. 38 were excluded as they were followed up locally. 2 were appropriately screened. Laboratory screening was complete in 80%. Renal function in 94%, full blood count in 94%, ALP in 90% and calcium in 84%. 23% underwent ocular review. ECG was undertaken in 45%. Cardiac involvement was suspected in 4 patients, of which 2 underwent appropriate screening with MRI. 39% were inappropriately screened with TTE. 58% were screened with ACE levels. Our audit suggests that adherence to guidelines at our institution is variable. Laboratory screening was most in-keeping with guidelines with over 80% screened, however there was poor implementation of ocular and cardiac investigations, with less than 50% screened appropriately. TTE and ACE levels may be over-ordered in our institution with 39% and 58% of testing outside guidelines.Increased screening awareness is required to detect occult involvement and utilise resources efficiently.