In COVID-19 Suspicion Without Severe Manifestations, Chest CT Sensitivity is not Sufficient for Triage: A Single-centre Experience

Year 2021, Volume: 74 Issue: 3, 343 - 351, 31.12.2021

Hakan Baş , Nihal Eker Türkan Nadir Öziş Murat Karakurt Emine Gül Aydın Özgür Akkale , Süheyla Ayça Gümüş Canan Demir , Abdulsamet Sandal , Mevlüt Karataş

Abstract

Objectives: In Coronavirus diseases-2019 (COVID-19), chest computed tomography’s (CT) benefits are controversial in the subgroup of asymptomatic
and mild-to-moderate symptomatic individuals. Since most patients are in this subgroup, for triage, it is necessary to choose the diagnostic tool
with the highest diagnostic performance and the least risk. We aimed to evaluate chest CT findings and the initial chest CT’s sensitivity in individuals
suspected of COVID-19 with no severe disease manifestations.

Materials and Methods: We conducted a retrospective study. Symptomatic individuals who had mild-to-moderate clinical manifestations and
asymptomatic individuals who had close contact with confirmed COVID-19 positive patient were eligible. Presenting severe clinical manifestations
was excluded. Reverse transcriptase-polymerase chain reaction (RT-PCR) and chest CT were performed on admission day. Consecutive nasopharyngeal
and oropharyngeal swab sampling, tested by RT-PCR, were accepted as the reference standard for definitive diagnosis of COVID-19.

Results: COVID-19 was confirmed in 161 of 214 patients via consecutive RT-PCR test. In 67 of 161 patients, pneumonia was detected by the initial
chest CT. Chest CT sensitivity was 41.6% [95% confidence interval (CI): 0.34-0.5], while the sensitivity of the initial RT-PCR test was 90.96% (95%
CI: 0.85-0.94); the area under the curve was significantly higher in the initial RT-PCR test (p<0.05).

Conclusion: The chest CT is not sensitive enough to be used in the triage of individuals suspected with COVID-19 in this subgroup without the
severe disease.

Keywords

COVID-19 , SARS-CoV-2 , Computed Tomography , Reverse Transcriptase Polymerase Chain Reaction

Ethical Statement

This study was performed in line with the principles of the Declaration of Helsinki. Clinical Research Ethics Committee of University of Health Sciences Turkey, Abdurrahman Yurtaslan Ankara Oncology Health Practice and Research Center granted approval for this retrospective data analysis

Supporting Institution

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Project Number

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Thanks

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Ciddi Belirtileri Olmayan COVID-19 Şüphesinde, Göğüs BT Duyarlılığı Triyaj İçin Yeterli Değildir: Tek Merkezli Bir Deneyim

Abstract

Amaç: Koronavirüs hastalığı-2019’da (COVID-19), asemptomatik ve hafif-orta semptomatik bireylerden oluşan alt grupta göğüs bilgisayarlı
tomografinin (BT) yararları tartışmalıdır. Çoğu hasta bu alt grupta olduğundan, triyaj için, en yüksek tanı performansına ve en az riske sahip
tanı aracını seçmek gerekir. Ağır hastalık bulguları olmayan COVID-19 şüphesi olan bireylerde göğüs BT bulgularını ve ilk göğüs BT duyarlılığını
değerlendirmeyi amaçladık.

Gereç ve Yöntem: Retrospektif bir çalışma yürüttük. Hafif-orta derecede klinik bulguları olan semptomatik bireyler ve COVID-19 pozitif hasta
ile yakın temasta bulunan asemptomatik bireyler çalışmaya dahil edilmiştir. Ağır klinik bulguları olan bireyler dışlandı. Başvuru gününde ters transkriptaz-polimeraz zincir reaksiyonu (RT-PCR) ve göğüs BT yapıldı. RT-PCR ile test edilen ardışık nazofarengeal ve orofarengeal sürüntüler,
COVID-19’un kesin tanısı için referans standart olarak kabul edildi.

Bulgular: Ardışık RT-PCR testleri ile 214 bireyin 161’inde COVID-19 doğrulandı. Göğüs BT’de 161 hastanın 67’sinde pnömoni saptandı. Göğüs BT
duyarlılığı %41,6 [%95 güven aralığı (GA): 0,34-0,5], iken ilk RT-PCR testinin duyarlılığı ise %90,96 (%95 GA: 0,85-0,94) bulundu. Eğrinin altındaki
alan, ilk RT-PCR testinde daha yüksektir (p<0,05).

Sonuç: Göğüs BT; COVID-19 şüphesi olan ve ağır hastalık bulguları olmayan alt grupta hasta triyajında kullanılacak kadar yeterli duyarlılıkta değildir

Keywords

COVID-19 , SARS-CoV-2 , Bilgisayarlı Tomografi , Ters Transkriptaz Polimeraz Zincir Reaksiyonu

Ethical Statement

This study was performed in line with the principles of the Declaration of Helsinki. Clinical Research Ethics Committee of University of Health Sciences Turkey, Abdurrahman Yurtaslan Ankara Oncology Health Practice and Research Center granted approval for this retrospective data analysis

Supporting Institution

-

Project Number

-

Thanks

-

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