Abstract
BackgroundCT chest severity score (CTSS) is a semi-quantitative measure done to correlate the severity of the pulmonary involvement on the CT with the severity of the disease.The objectives of this study are to describe chest CT criteria and CTSS of the COVID-19 infection in pediatric oncology patients, to find a cut-off value of CTSS that can differentiate mild COVID-19 cases that can be managed at home and moderate to severe cases that need hospital care.A retrospective cohort study was conducted on 64 pediatric oncology patients with confirmed COVID-19 infection between 1 April and 30 November 2020. They were classified clinically into mild, moderate, and severe groups. CT findings were evaluated for lung involvement and CTSS was calculated and range from 0 (clear lung) to 20 (all lung lobes were affected).ResultsOverall, 89% of patients had hematological malignancies and 92% were under active oncology treatment. The main CT findings were ground-glass opacity (70%) and consolidation patches (62.5%). In total, 85% of patients had bilateral lung involvement, ROC curve showed that the area under the curve of CTSS for diagnosing severe type was 0.842 (95% CI 0.737–0.948). The CTSS cut-off of 6.5 had 90.9% sensitivity and 69% specificity, with 41.7% positive predictive value (PPV) and 96.9% negative predictive value (NPV). According to the Kaplan–Meier analysis, mortality risk was higher in patients with CT score > 7 than in those with CTSS < 7.ConclusionPediatric oncology patients, especially those with hematological malignancies, are more vulnerable to COVID-19 infection. Chest CT severity score > 6.5 (about 35% lung involvement) can be used as a predictor of the need for hospitalization.
Highlights
computed tomography (CT) chest severity score (CTSS) is a semi-quantitative measure done to correlate the severity of the pulmonary involvement on the CT with the severity of the disease
We aimed to describe appropriate chest CT criteria and the severity of COVID-19 infection in pediatric oncology patients as a special group, to find a cut-off value of chest CTSS that can differentiate (i) mild cases not requiring oxygen support that can be managed at home and (ii) moderate/severe cases that need oxygen support or intensive care unit (ICU) admission, allowing appropriate management
intraclass correlation coefficient (ICC) values of < 0.4, 0.4–0.75, and > 0.75 represent poor, moderate, and good repeatability, respectively. This cohort study of 69 consecutive pediatric oncology patients proven to be positive by Reverse-transcription polymerase chain reaction (RT-PCR) for COVID-19 was performed between 1 April and 30 November 2020
Summary
CT chest severity score (CTSS) is a semi-quantitative measure done to correlate the severity of the pulmonary involvement on the CT with the severity of the disease. The objectives of this study are to describe chest CT criteria and CTSS of the COVID-19 infection in pediatric oncology patients, to find a cut-off value of CTSS that can differentiate mild COVID-19 cases that can be managed at home and moderate to severe cases that need hospital care. A retrospective cohort study was conducted on 64 pediatric oncology patients with confirmed COVID-19 infection between 1 April and 30 November 2020. They were classified clinically into mild, moderate, and severe groups. Chest CT severity score (CTSS) is a semiquantitative measure used to correlate the severity of pulmonary involvement on CT with the severity of the disease [12]. CTSS of COVID-19 was used as a special imaging tool for assessing the severity of COVID-19 infection in the adult patient [12, 16, 18], a prognostic prediction for the clinical course [15, 17], and a prognostic value in hospitalized patients with COVID-19 [19]
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