Multidisciplinary Approach in COVID-19 Pneumonia: A Backward Path by an Expert Team

Abstract Background: The novel coronavirus disease 2019 (COVID-19) represents a medical challenge worldwide. COVID-19 pneumonia is an extremely complex disease. 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.Methods: Two pulmonologists, two radiologists, and two pathologists reviewed 27 patients who died of 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. Pulmonologists, radiologists and pathologists were asked to classify every case into four distinct levels of diagnostic certainty, based on clinical, radiological, and morphological/virologic data obtained from an autoptic lung sample, respectively. The whole lung examination was considered the gold standard for the final diagnosis. The probability of a correct diagnosis was calculated, and the effectiveness of a multidisciplinary diagnosis was obtained by comparing diagnoses made by experienced pulmonologists with those made by non-pulmonologists. Results: COVID-19 pneumonia was excluded in 2 cases (8%) and was a marginal feature in 3 cases (11%). The probability of a correct diagnosis increased strikingly from an undedicated clinician to an expert specialist, becoming progressively more accurate at different steps. 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.Conclusions: In summary, the dynamic interaction between expert specialists significantly improves the diagnostic confidence and management of patients with COVID-19 pneumonia.