Calabrese Fiorella, Pezzuto Federica, Giraudo Chiara, Vedovelli Luca, Fortarezza Francesco, Del Vecchio Claudia, Lunardi Francesca, Fraia Anna Sara, Cocconcelli Elisabetta, Vuljan Stefania Edith, Gregori Dario, Crisanti Andrea, Balestro Elisabetta, Spagnolo Paolo
Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy.
Department of Medicine, University of Padova, Medical School, Padova, Italy.
Front Med (Lausanne). 2021 Apr 1;8:637872. doi: 10.3389/fmed.2021.637872. eCollection 2021.
The hypothesis of the study was that a multidisciplinary approach involving experienced specialists in diffuse parenchymal lung disease might improve the diagnosis of patients with COVID-19 pneumonia. Two pulmonologists, two radiologists, and two pathologists reviewed 27 patients affected by severe COVID-19 pneumonia as the main diagnosis made by non-pulmonologists. To evaluate whether the contribution of specialists, individually and/or in combination, might modify the original diagnosis, a three-step virtual process was planned. The whole lung examination was considered the gold standard for the final diagnosis. The probability of a correct diagnosis was calculated using a model based on generalized estimating equations. The effectiveness of a multidisciplinary diagnosis was obtained by comparing diagnoses made by experienced pulmonologists with those made by non-pulmonologists. In 19% of cases, the diagnosis of COVID-19-related death was mainly incorrect. The probability of a correct diagnosis increased strikingly from an undedicated clinician to an expert specialist. Every single specialist made significantly more correct diagnoses than any non-pulmonologist. The highest level of accuracy was achieved by the combination of 3 expert specialists ( = 0.0003). The dynamic interaction between expert specialists may significantly improve the diagnostic confidence and management of patients with COVID-19 pneumonia.
该研究的假设是，由弥漫性实质性肺疾病方面经验丰富的专家组成的多学科方法可能会改善对新冠肺炎肺炎患者的诊断。两名肺科医生、两名放射科医生和两名病理学家对27例以严重新冠肺炎肺炎为主要诊断（由非肺科医生做出）的患者进行了评估。为了评估专家单独和/或联合起来的贡献是否可能改变最初的诊断，计划了一个三步虚拟流程。全肺检查被视为最终诊断的金标准。使用基于广义估计方程的模型计算正确诊断的概率。通过比较经验丰富的肺科医生做出的诊断与非肺科医生做出的诊断，得出多学科诊断的有效性。在19%的病例中，与新冠肺炎相关死亡的诊断主要是错误的。从非专科医生到专家，正确诊断的概率显著增加。每一位专家做出的正确诊断都比任何非肺科医生显著更多。由3名专家组成的团队实现了最高水平的准确性（P = 0.0003）。专家之间的动态互动可能会显著提高新冠肺炎肺炎患者的诊断信心和管理水平。
