Diagnostic performance of chest radiography in high COVID-19 prevalence setting: experience from a European reference hospital.

Autor: Flor N; U.O. di Radiodiagnostica, Ospedale L. Sacco ASST Fatebenefratelli Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, MI, Italy. nicola.flor@unimi.it.; Unità Operativa di Radiologia, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy. nicola.flor@unimi.it., Saggiante L; Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy., Savoldi AP; Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy., Vitale R; Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy., Casazza G; Dipartimento di Scienze Biomediche e Cliniche 'L. Sacco', Università degli Studi di, Milan, MI, Italy., Villa P; U.O. di Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale L. Sacco ASST Fatebenefratelli Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, MI, Italy., Brambilla AM; U.O. di Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale L. Sacco ASST Fatebenefratelli Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, MI, Italy.
Jazyk: angličtina
Zdroj: Emergency radiology [Emerg Radiol] 2021 Oct; Vol. 28 (5), pp. 877-885. Date of Electronic Publication: 2021 Jul 03.
DOI: 10.1007/s10140-021-01946-x
Abstrakt: Purpose: The study's aim is to analyse the diagnostic performance of chest radiography (CXR) in patients with suspected coronavirus disease 19 (COVID-19).
Methods: We retrospectively considered 826 consecutive patients with suspected COVID-19 presenting to our emergency department (ED) from February 21 to March 31, 2020, in a high disease prevalence setting. We enrolled patients who underwent CXR and rhino-oropharyngeal swab for real-time reverse transcription-polymerase chain reaction (rRT-PCR). CXRs were evaluated by an expert radiologist; a second independent analysis was performed by two residents in consensus. All readers, blinded to rRT-PCR results, classified CXRs positive/negative depending on presence/absence of typical findings of COVID-19, using rRT-PCR as reference standard.
Results: We finally analysed 680 patients (median age 58); 547 (80%) tested positive for COVID-19. The diagnostic performance of CXR, interpreted by the expert reader, was as follows: sensitivity (79.0%; 95% CI: 75.3-82.3), specificity (81.2%; 95% CI: 73.5-87.5), PPV (94.5%;95% CI: 92.0-96.4), NPV (48.4%; 95% CI: 41.7-55.2), and accuracy (79.3%; 95% CI: 76.0-82.2). For the residents: sensitivity (75.1%; 95% CI: 71.2-78.7), specificity (57.9%; 95% CI: 49.9-66.4), PPV (88.0%; 95% CI: 84.7-90.8), NPV (36.2%; 95% CI: 29.7-43.0), and accuracy (71.6%; 95% CI: 68.1-75.0). We found a significant difference between the reporting sensitivity (p = 0.013) and specificity (p < 0.0001) of expert radiologist vs residents. CXR sensitivity was higher in patients with symptom onset > 5 days before ED presentation compared to ≤ 5 days (84.4% vs 70.7%).
Conclusions: CXR showed a sensitivity of 79% and a specificity of 81% in diagnosing viral pneumonia in symptomatic patients with clinical suspicion of COVID-19. Further studies in lower prevalence settings are needed.
(© 2021. The Author(s).)
Databáze: MEDLINE
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