Abstract
Purpose:To investigate the role of low-dose chest computed tomography (CT) imaging in the triage of patients suspected of coronavirus disease 2019 (COVID-19) in an emergency setting.Materials and Methods:Data from 610 patients admitted to our emergency unit from March 20, 2020, until April 11, 2020, with suspicion of COVID-19 were collected. Diagnostic values of low-dose chest CT for COVID-19 were calculated using consecutive reverse-transcription polymerase chain reaction (RT-PCR) tests and bronchoalveolar lavage (BAL) as reference. Comparative analysis of the 199 COVID-19 positive versus 411 COVID-19 negative patients was done with identification of risk factors and predictors of worse outcome.Results:Sensitivity and specificity of low-dose CT for the diagnosis of COVID-19 respectively ranged from 75% (150/199) to 88% (175/199) and 94% (386/411) to 99% (386/389), depending on the inclusion of inconclusive results. On multivariate analysis, a higher body mass index (BMI), fever, and dyspnea on admission were risk factors for COVID-19 (all p-values < 0.05). The mortality rate was 12.6% (25/199). Higher age and high levels of C-reactive protein (CRP) and D-dimers were predictors of worse outcome (all p-values < 0.05).Conclusion:Low-dose chest CT has a high specificity and a moderate to high sensitivity in symptomatic patients with suspicion of COVID-19 and could be used as an effective tool in setting of triage in high-prevalence areas.
Highlights
Sensitivity and specificity of low-dose computed tomography (CT) for the diagnosis of COVID-19 respectively ranged from 75% (150/199) to 88% (175/199) and 94% (386/411) to 99% (386/389), depending on the inclusion of inconclusive results
The diagnosis of coronavirus disease 2019 (COVID-19) pneumonia can be very challenging based on symptoms alone, because there is a great overlap with other conditions
Based on nasopharyngeal or bronchoalveolar lavage (BAL) reverse– transcription polymerase chain reaction (RT-PCR) results, 199 patients (33%) were considered COVID-19 positive and 411 (67%) COVID-19 negative
Summary
The diagnosis of coronavirus disease 2019 (COVID-19) pneumonia can be very challenging based on symptoms alone, because there is a great overlap with other conditions. The diagnosis highly depends on nasopharyngeal swab reverse– transcription polymerase chain reaction (RT-PCR) testing. These tests have high specificity but rather low sensitivity, with reported falsenegative rates ranging from 5–40%, depending on the assay, time of testing, and quality of the specimen [1]. It can take hours before the results are present, making it challenging as a screening tool in an emergency setting. The reported sensitivity and specificity of chest CT for the diagnosis of COVID-19 vary widely (60–98% and 25–72%, respectively) [3,4,5,6]
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