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Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience

BACKGROUND: Clinicians need rapid and reliable diagnosis of coronavirus disease 2019 (COVID-19) for proper risk stratification, isolation strategies, and treatment decisions. PURPOSE: To assess the real-life performance of radiologist emergency department chest CT interpretation for diagnosing COVID...

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Autores principales: Schalekamp, S., Bleeker-Rovers, C.P., Beenen, L.F.M., Quarles van Ufford, H.M.E., Gietema, H.A., Stöger, J.L., Harris, V., Reijers, M.H.E., Rahamat-Langendoen, J., Korevaar, D.A., Smits, L.P., Korteweg, C., van Rees Vellinga, T., Vermaat, M., Stassen, P.M., Scheper, H., Wijnakker, R., Borm, F.J., Dofferhoff, A.S.M., Prokop, W.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Radiological Society of North America 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676748/
https://www.ncbi.nlm.nih.gov/pubmed/33201791
http://dx.doi.org/10.1148/radiol.2020203465
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author Schalekamp, S.
Bleeker-Rovers, C.P.
Beenen, L.F.M.
Quarles van Ufford, H.M.E.
Gietema, H.A.
Stöger, J.L.
Harris, V.
Reijers, M.H.E.
Rahamat-Langendoen, J.
Korevaar, D.A.
Smits, L.P.
Korteweg, C.
van Rees Vellinga, T.
Vermaat, M.
Stassen, P.M.
Scheper, H.
Wijnakker, R.
Borm, F.J.
Dofferhoff, A.S.M.
Prokop, W.M.
author_facet Schalekamp, S.
Bleeker-Rovers, C.P.
Beenen, L.F.M.
Quarles van Ufford, H.M.E.
Gietema, H.A.
Stöger, J.L.
Harris, V.
Reijers, M.H.E.
Rahamat-Langendoen, J.
Korevaar, D.A.
Smits, L.P.
Korteweg, C.
van Rees Vellinga, T.
Vermaat, M.
Stassen, P.M.
Scheper, H.
Wijnakker, R.
Borm, F.J.
Dofferhoff, A.S.M.
Prokop, W.M.
author_sort Schalekamp, S.
collection PubMed
description BACKGROUND: Clinicians need rapid and reliable diagnosis of coronavirus disease 2019 (COVID-19) for proper risk stratification, isolation strategies, and treatment decisions. PURPOSE: To assess the real-life performance of radiologist emergency department chest CT interpretation for diagnosing COVID-19 during the acute phase of the pandemic, using the COVID-19 reporting and data system (CO-RADS). MATERIALS AND METHODS: This retrospective multicenter study included consecutive patients who presented to emergency departments in six medical centers between March and April 2020 with moderate to severe upper respiratory symptoms suspicious for COVID-19. As part of clinical practice, chest CT was obtained for primary workup and scored using the 5-point CO-RADS scheme for suspicion of COVID-19. CT was compared with SARS-CoV-2 RT-PCR, and a clinical reference standard established by a multidisciplinary group of clinicians based on RT-PCR, COVID-19 contact history, oxygen therapy, timing of RT-PCR testing and likely alternative diagnosis. Performance of CT was estimated using area under the receiver operating characteristics curve (AUC) analysis and diagnostic odds ratios (OR) against both reference standards. Subgroup analysis was performed based on symptom duration grouped presentations of < 48 hours, 48 hours through 7 days, and > 7 days. RESULTS: A total of 1070 patients (median age 66, IQR 54-75, 626 men) were included, of whom 536/1070 (50%) had a positive RT-PCR, 137/1070 (13%) patients were considered to have a possible or probable COVID- 19 based on the clinical reference standard. Chest CT yielded an AUC of 0.87 (95%CI 0.84-0.89) compared with RT-PCR and 0.87 (95%CI 0.85-0.89) compared with the clinical reference standard. A CO-RADS score ≥4 yielded an OR of 25.9 (95%CI 18.7-35.9) for a COVID-19 diagnosis by RT-PCR, and an OR of 30.6 (95%CI 21.1-44.4) by the clinical reference standard. For symptom duration of less than 48 hours, the AUC fell to 0.71 (95%CI 0.62-0.80; P<.001). CONCLUSION: Chest CT analysis using the COVID-19 reporting and data system (CO-RADS) enables rapid and reliable diagnosis of COVID-19, particularly when symptom duration is greater than 48 hours. See also the editorial by Elicker.
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spelling pubmed-76767482020-11-19 Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience Schalekamp, S. Bleeker-Rovers, C.P. Beenen, L.F.M. Quarles van Ufford, H.M.E. Gietema, H.A. Stöger, J.L. Harris, V. Reijers, M.H.E. Rahamat-Langendoen, J. Korevaar, D.A. Smits, L.P. Korteweg, C. van Rees Vellinga, T. Vermaat, M. Stassen, P.M. Scheper, H. Wijnakker, R. Borm, F.J. Dofferhoff, A.S.M. Prokop, W.M. Radiology Original Research BACKGROUND: Clinicians need rapid and reliable diagnosis of coronavirus disease 2019 (COVID-19) for proper risk stratification, isolation strategies, and treatment decisions. PURPOSE: To assess the real-life performance of radiologist emergency department chest CT interpretation for diagnosing COVID-19 during the acute phase of the pandemic, using the COVID-19 reporting and data system (CO-RADS). MATERIALS AND METHODS: This retrospective multicenter study included consecutive patients who presented to emergency departments in six medical centers between March and April 2020 with moderate to severe upper respiratory symptoms suspicious for COVID-19. As part of clinical practice, chest CT was obtained for primary workup and scored using the 5-point CO-RADS scheme for suspicion of COVID-19. CT was compared with SARS-CoV-2 RT-PCR, and a clinical reference standard established by a multidisciplinary group of clinicians based on RT-PCR, COVID-19 contact history, oxygen therapy, timing of RT-PCR testing and likely alternative diagnosis. Performance of CT was estimated using area under the receiver operating characteristics curve (AUC) analysis and diagnostic odds ratios (OR) against both reference standards. Subgroup analysis was performed based on symptom duration grouped presentations of < 48 hours, 48 hours through 7 days, and > 7 days. RESULTS: A total of 1070 patients (median age 66, IQR 54-75, 626 men) were included, of whom 536/1070 (50%) had a positive RT-PCR, 137/1070 (13%) patients were considered to have a possible or probable COVID- 19 based on the clinical reference standard. Chest CT yielded an AUC of 0.87 (95%CI 0.84-0.89) compared with RT-PCR and 0.87 (95%CI 0.85-0.89) compared with the clinical reference standard. A CO-RADS score ≥4 yielded an OR of 25.9 (95%CI 18.7-35.9) for a COVID-19 diagnosis by RT-PCR, and an OR of 30.6 (95%CI 21.1-44.4) by the clinical reference standard. For symptom duration of less than 48 hours, the AUC fell to 0.71 (95%CI 0.62-0.80; P<.001). CONCLUSION: Chest CT analysis using the COVID-19 reporting and data system (CO-RADS) enables rapid and reliable diagnosis of COVID-19, particularly when symptom duration is greater than 48 hours. See also the editorial by Elicker. Radiological Society of North America 2020-11-17 /pmc/articles/PMC7676748/ /pubmed/33201791 http://dx.doi.org/10.1148/radiol.2020203465 Text en 2020 by the Radiological Society of North America, Inc. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle Original Research
Schalekamp, S.
Bleeker-Rovers, C.P.
Beenen, L.F.M.
Quarles van Ufford, H.M.E.
Gietema, H.A.
Stöger, J.L.
Harris, V.
Reijers, M.H.E.
Rahamat-Langendoen, J.
Korevaar, D.A.
Smits, L.P.
Korteweg, C.
van Rees Vellinga, T.
Vermaat, M.
Stassen, P.M.
Scheper, H.
Wijnakker, R.
Borm, F.J.
Dofferhoff, A.S.M.
Prokop, W.M.
Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience
title Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience
title_full Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience
title_fullStr Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience
title_full_unstemmed Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience
title_short Chest CT in the Emergency Department for Diagnosis of COVID-19 Pneumonia: Dutch Experience
title_sort chest ct in the emergency department for diagnosis of covid-19 pneumonia: dutch experience
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676748/
https://www.ncbi.nlm.nih.gov/pubmed/33201791
http://dx.doi.org/10.1148/radiol.2020203465
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