Unenhanced computed tomography (CT) utility for triage at the emergency department during COVID-19 pandemic

Autor: Ioannis Skalidis, Nicole Petriccioli, Lauriane Poli, Rui Ribeiro Da Costa, Alain Bigin Younossian, Hugo Bothorel, Vinh-Kim Nguyen, Omar Kherad
Rok vydání: 2020
Předmět:
Male
TN
True Negative
PPV
Positive Predictive Value
Computed tomography
0302 clinical medicine
ED
Emergency department
Clinical information
Medicine
NEWS
National Early Warning Score
Lung
COVID-19
Coronavirus disease 2019
medicine.diagnostic_test
General Medicine
Hospital based
Middle Aged
Screening
Emergency Medicine
Female
Radiology
Emergency Service
Hospital
ACR
American college of radiology
FP
False Positive
CT
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
RT-PCR
Article
NRI
Net Reclassification Improvement
03 medical and health sciences
Humans
NPV
Negative Predictive Value
In patient
Pandemics
Retrospective Studies
Emergency department triage
Pandemic
business.industry
SARS-CoV-2
COVID-19
RT-PCR
Reverse transcription polymerase chain reaction
030208 emergency & critical care medicine
Emergency department
Triage
LDCT
Low dose Computed Tomography
Coronavirus
FN
False Negative
TP
True Positive
business
Tomography
X-Ray Computed
Zdroj: The American Journal of Emergency Medicine
ISSN: 1532-8171
Popis: Background Unenhanced chest computed tomography (CT) can assist in the diagnosis and classification of coronavirus disease 2019 (COVID-19), complementing to the reverse-transcription polymerase chain reaction (RT-PCR) tests; the performance of which has yet to be validated in emergency department (ED) setting. The study sought to evaluate the diagnostic performance of chest CT in the diagnosis and management of COVID-19 in ED. Methods This retrospective single-center study included 155 patients in ED who underwent both RT-PCR and chest CT for suspected COVID-19 from March 1st to April 1st, 2020. The clinical information, CT images and laboratory reports were reviewed and the performance of CT was assessed, using the RT-PCR as standard reference. Moreover, an adjudication committee retrospectively rated the probability of COVID-19 before and after the CT calculating the net reclassification improvement (NRI). Their final diagnosis was considered as reference. The proportion of patients with negative RT-PCR test that was directed to the referent hospital based on positive CT findings was also assessed. Results Among 155 patients, 42% had positive RT-PCR results, and 46% had positive CT findings. Chest CT showed a sensitivity of 84.6%, a specificity of 80.0% and a diagnostic accuracy of 81.9% in suggesting COVID-19 with RT-PCR as reference. Concurrently, corresponding values of 89.4%, 84.3% and 86.5% were retrieved with the adjudication committee diagnosis as reference. For the subgroup of patients with age > 65, specificity and sensitivity were 50% and 80.8%, respectively. In patients with negative RT-PCR results, 20% (18/90) had positive chest CT finding and 22% (4/18) of those were eventually considered as COVID-19 positive according to the adjudication committee. After CT, the estimated probability of COVID-19 changed in 10/104 (11%) patients with available data: 4 (4%) were downgraded, 6 (6%) upgraded. The NRI was 1.92% (NRI event −2.08% + NRI non-event 5.36%). No patient with negative RT-PCR but positive CT was eventually directed to hospital. Conclusion Chest CT showed promising sensitivity for diagnosing COVID-19 across all patients' subgroups. However, CT did not modify the estimated probability of COVID-19 infection in a substantial proportion of patients and its utility as an emergency department triage tool warrants further analyses.
Databáze: OpenAIRE
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