TY - JOUR T1 - Accuracy of the multidisciplinary diagnosis of COVID-19 in patients with negative nasopharyngeal swabs RT-PCR, evaluated using BAL as diagnostic gold standard JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2021.PA840 VL - 58 IS - suppl 65 SP - PA840 AU - Sara Tomassetti AU - Valentina Luzzi AU - Giulia Biadene AU - Guja Bernacchi AU - Leonardo Gori AU - Sonia Bambina AU - Marco De Martino AU - Edoardo Cavigli AU - Diletta Cozzi AU - Vittorio Miele AU - Gianmaria Rossolini AU - Simona Pollini AU - Cosimo Nardi AU - Anna Peired AU - Alessandro Morettini AU - Carlo Nozzoli AU - Adriana Poggesi AU - Lorenzo Menicacci AU - Valentina Scotti AU - Giogia Falchetti AU - Elias Romano AU - Ombretta Para AU - Lorenzo Caruso AU - Federico Lavorini Y1 - 2021/09/05 UR - http://erj.ersjournals.com/content/58/suppl_65/PA840.abstract N2 - Aim: The aim of this study was to evaluate the accuracy of the MDT (multi disciplinary team) diagnosis of COVID-19 with negative nasal swabs. BAL was considered the diagnostic gold standard. Methods:This is an interim analysis of a substudy of the Dragon project (IMI2 - Call 21;#101005122). All consecutive patients admitted at Florence University Hospital for suspected COVID-19, that resulted negative to two consecutive nasal swabs, underwent BAL. MDTs with different expertise levels were asked to provide a provisional diagnosis (up to three choices allowed), confidence levels and management decision (patient allocation and treatment) after reviewing clinical, HRCT and BAL data in a stepwise fashion.Results: 86 patients, median age 63 years (range 19-90), 52 males (60.5%), 50 (60%)  current or former smokers. 83 (95%) patients had one or more comorbidities (median 3, rage 1-10; Charlson CI  4.6, 0-11). BMI 24.3 (14.3-24.5), P/F 295 (76-547). Only 7 cases were found positive on BAL (8.4%). For the MDT 1 sensitivity, specificity, positive and negative predictive value were respectively: 28% (2/7), 60% (48/79), 6% (2/33), 90% (48/53). For the MDT2 (younger) sensitivity, specificity, positive and negative predictive value were respectively: 57% (4/7), 81% (64/79), 21% (4/19), 95% (64/67). The concordance between the two MDTs was poor: 60% of cases, with a kappa of 0.09 (SE 0.1). Conclusions:The negative predictive value of a MDT diagnosis of COVID-19 is high irrespective of expertise level of the MDTs. The sensitivity and the positive predictive value are miserable and the inter-observer variability is strikingly high.FootnotesCite this article as: European Respiratory Journal 2021; 58: Suppl. 65, PA840.This abstract was presented at the 2021 ERS International Congress, in session “Prediction of exacerbations in patients with COPD”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -