Diagnosis of primary ciliary dyskinesia: discrepancy according to different algorithms

Background Diagnosis of primary ciliary dyskinesia (PCD) is challenging since them is no gold standard test. The European Respiratory (ERS) and American Thoracic (ATS) Societies developed evidence-based diagnostic guidelines with considerable differences. Objective We aimed to compare the algorithms published by the ERS and the ATS with each other and with our own PCD-UNIBE algorithm in a clinical setting. Our algorithm is similar to the ERS algorithm with additional immunofluorescence staining. Agreement (Cohen's x) and concordance between the three algorithms were assessed in patients with suspicion of PCD referred to our diagnostic centre. Results In 46 out of 54 patients (85%) the final diagnosis was concordant between all three algorithms (30 PCD negative, 16 PCD positive). In eight patients (15%) PCD diagnosis differed between the algorithms. Five patients (9%) were diagnosed as PCD only by the ATS, one (2%) only by the ERS and PCD-UNIBE, one (2%) only by the ATS and PCD-UNIBE, and one (2%) only by the PCD-UNIBE algorithm. Agreement was substantial between the ERS and the ATS (c=0.72, 95% CI 0.53-0.92) and the ATS and the PCD-UNIBE (kappa=0.73, 95% CI 0.53-0.92) and almost perfect between the ERS and the PCD-UNIBE algorithms (kappa=0.92, 95% CI 0.80-1.00). Conclusion The different diagnostic algorithms lead to a contradictory diagnosis in a considerable proportion of patients. Thus, an updated, internationally harmonised and standardised PCD diagnostic algorithm is needed to improve diagnostics for these discordant cases.

Automated summary

There are significant differences in diagnosis consistency between the algorithms developed by ERS, ATS, and PCD-UNIBE, with 15% of patients having contradictory diagnoses. Further efforts are needed to develop an updated, internationally harmonised, and standardised PCD diagnostic algorithm to improve diagnosis in discordant cases.