TY - JOUR
T1 - CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands
T2 - A prospective study
AU - Gietema, Hester A.
AU - Zelis, Noortje
AU - Nobel, J. Martijn
AU - Lambriks, Lars J. G.
AU - van Alphen, Lieke B.
AU - Lashof, Astrid M. L. Oude
AU - Wildberger, Joachim E.
AU - Nelissen, Irene C.
AU - Stassen, Patricia M.
PY - 2020/7/9
Y1 - 2020/7/9
N2 - IntroductionEarly differentiation between emergency department (ED) patients with and without corona virus disease (COVID-19) is very important. Chest CT scan may be helpful in early diagnosing of COVID-19. We investigated the diagnostic accuracy of CT using RT-PCR for SARS-CoV-2 as reference standard and investigated reasons for discordant results between the two tests.MethodsIn this prospective single centre study in the Netherlands, all adult symptomatic ED patients had both a CT scan and a RT-PCR upon arrival at the ED. CT results were compared with PCR test(s). Diagnostic accuracy was calculated. Discordant results were investigated using discharge diagnoses.ResultsBetween March 13(th)and March 24(th)2020, 193 symptomatic ED patients were included. In total, 43.0% of patients had a positive PCR and 56.5% a positive CT, resulting in a sensitivity of 89.2%, specificity 68.2%, likelihood ratio (LR)+ 2.81 and LR- 0.16. Sensitivity was higher in patients with high risk pneumonia (CURB-65 score >= 3; n = 17, 100%) and with sepsis (SOFA score >= 2; n = 137, 95.5%). Of the 35 patients (31.8%) with a suspicious CT and a negative RT-PCR, 9 had another respiratory viral pathogen, and in 7 patients, COVID-19 was considered likely. One of nine patients with a non-suspicious CT and a positive PCR had developed symptoms within 48 hours before scanning.DiscussionThe accuracy of chest CT in symptomatic ED patients is high, but used as a single diagnostic test, CT can not safely diagnose or exclude COVID-19. However, CT can be used as a quick tool to categorize patients into "probably positive" and "probably negative" cohorts.
AB - IntroductionEarly differentiation between emergency department (ED) patients with and without corona virus disease (COVID-19) is very important. Chest CT scan may be helpful in early diagnosing of COVID-19. We investigated the diagnostic accuracy of CT using RT-PCR for SARS-CoV-2 as reference standard and investigated reasons for discordant results between the two tests.MethodsIn this prospective single centre study in the Netherlands, all adult symptomatic ED patients had both a CT scan and a RT-PCR upon arrival at the ED. CT results were compared with PCR test(s). Diagnostic accuracy was calculated. Discordant results were investigated using discharge diagnoses.ResultsBetween March 13(th)and March 24(th)2020, 193 symptomatic ED patients were included. In total, 43.0% of patients had a positive PCR and 56.5% a positive CT, resulting in a sensitivity of 89.2%, specificity 68.2%, likelihood ratio (LR)+ 2.81 and LR- 0.16. Sensitivity was higher in patients with high risk pneumonia (CURB-65 score >= 3; n = 17, 100%) and with sepsis (SOFA score >= 2; n = 137, 95.5%). Of the 35 patients (31.8%) with a suspicious CT and a negative RT-PCR, 9 had another respiratory viral pathogen, and in 7 patients, COVID-19 was considered likely. One of nine patients with a non-suspicious CT and a positive PCR had developed symptoms within 48 hours before scanning.DiscussionThe accuracy of chest CT in symptomatic ED patients is high, but used as a single diagnostic test, CT can not safely diagnose or exclude COVID-19. However, CT can be used as a quick tool to categorize patients into "probably positive" and "probably negative" cohorts.
KW - CORONAVIRUS DISEASE
KW - PNEUMONIA
KW - SENSITIVITY
KW - CHEST CT
U2 - 10.1371/journal.pone.0235844
DO - 10.1371/journal.pone.0235844
M3 - Article
C2 - 32645053
SN - 1932-6203
VL - 15
JO - PLOS ONE
JF - PLOS ONE
IS - 7
M1 - 0235844
ER -