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

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

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

References

1. 1. Li B, Li X, Wang Y, et al. Diagnostic value and key features of computed tomography in Coronavirus Disease 2019. Emerg Microbes Infect. 2020;9:787-793.
2. 2. Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill. 2020;25:2000058.
3. 3. Liu K, Fang YY, Deng Y, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;133:1025- 1031.
4. 4. Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci. 2020;63:706-711.
5. 5. He JL, Luo L, Luo ZD, et al. Diagnostic performance between CT and initial real-time RT-PCR for clinically suspected 2019 coronavirus disease (COVID-19) patients outside Wuhan, China. Respir Med. 2020;168:105980.
6. 6. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020;323:1843-1844.
7. 7. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708-1720.
8. 8. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323:1061-1069.

9. 9. Xu B, Xing Y, Peng J, et al. Chest CT for detecting COVID-19: a systematic review and meta-analysis of diagnostic accuracy. Eur Radiol. 2020;30:5720- 5727.
10. 10. Rubin GD, Ryerson CJ, Haramati LB, et al. The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A Multinational Consensus Statement From the Fleischner Society. Chest. 2020;158:106-116.
11. 11. Frush DP, Donnelly LF, Rosen NS. Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics. 2003;112:951- 957.
12. 12. Şendur HN. Adherence to ALARA principle in the era of COVID-19 pandemic. Diagn Interv Radiol. 2021;27:153.
13. 13. Clinical management of COVID-19: interim guidance, https://www.who.int/ publications/i/item/clinical-management-of-covid-19 (27 May 2020).
14. 14. Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. J Thorac Imaging. 2020;35:219-227.
15. 15. Mizumoto K, Kagaya K, Zarebski A, et al. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020;25:2000180.
16. 16. Kim GU, Kim MJ, Ra SH, et al. Clinical characteristics of asymptomatic and symptomatic patients with mild COVID-19. Clin Microbiol Infect. 2020;26:948.e1-948.e3
17. 17. Yamagishi T, Kamiya H, Kakimoto K, et al. Descriptive study of COVID-19 outbreak among passengers and crew on Diamond Princess cruise ship, Yokohama Port, Japan, 20 January to 9 February 2020. Euro Surveill. 2020;25:2000272.
18. 18. Corman VM, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020;25:2000045.
19. 19. Hui DSC, Zumla A. Severe Acute Respiratory Syndrome: Historical, Epidemiologic, and Clinical Features. Infect Dis Clin North Am. 2019;33:869- 889.
20. 20. Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767-1772.
21. 21. Fang Y, Zhang H, Xie J, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020;296:E115-E117. 22. Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020;30:4407- 4416.
22. 23. Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296:E32-E40.
23. 24. Mohammadi A, Esmaeilzadeh E, Li Y, et al. SARS-CoV-2 detection in different respiratory sites: A systematic review and meta-analysis. EBioMedicine. 2020;59:102903.
24. 25. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357:2277-2284.