tetano
Editor, Senior Moderator
Eur Radiol
. 2020 Aug 19.
doi: 10.1007/s00330-020-07154-4. Online ahead of print.
Chest CT for rapid triage of patients in multiple emergency departments during COVID-19 epidemic: experience report from a large French university hospital
Victoria Ducray[SUP] 1 [/SUP], Anna Sesilia Vlachomitrou[SUP] 2 [/SUP], Maude Bouscambert-Duchamp[SUP] 3 4 [/SUP], Salim Si-Mohamed[SUP] 5 6 7 [/SUP], Sylvain Gouttard[SUP] 1 [/SUP], Adeline Mansuy[SUP] 1 [/SUP], Florian Wickert[SUP] 8 [/SUP], Alain Sigal[SUP] 9 [/SUP], Alexandre Gaymard[SUP] 3 4 [/SUP], Fran?ois Talbot[SUP] 10 [/SUP], Catherine Michel[SUP] 10 [/SUP], Thomas Perpoint[SUP] 11 [/SUP], Jean-Baptiste Pialat[SUP] 1 8 [/SUP], Olivier Rouviere[SUP] 1 12 [/SUP], Laurent Milot[SUP] 1 [/SUP], Fran?ois Cotton[SUP] 1 8 [/SUP], Philippe Douek[SUP] 1 8 [/SUP], Muriel Rabilloud[SUP] 13 [/SUP], Loic Boussel[SUP] 1 8 [/SUP], COVID-Outcomes-HCL Consortium
Collaborators, Affiliations
Abstract
Objectives: To assess the diagnostic performances of chest CT for triage of patients in multiple emergency departments during COVID-19 epidemic, in comparison with reverse transcription polymerase chain reaction (RT-PCR) test.
Method: From March 3 to April 4, 2020, 694 consecutive patients from three emergency departments of a large university hospital, for which a hospitalization was planned whatever the reasons, i.e., COVID- or non-COVID-related, underwent a chest CT and one or several RT-PCR tests. Chest CTs were rated as "Surely COVID+," "Possible COVID+," or "COVID-" by experienced radiologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the final RT-PCR test as standard of reference. The delays for CT reports and RT-PCR results were recorded and compared.
Results: Among the 694 patients, 287 were positive on the final RT-PCR exam. Concerning the 694 chest CT, 308 were rated as "Surely COVID+", 34 as "Possible COVID+," and 352 as "COVID-." When considering only the "Surely COVID+" CT as positive, accuracy, sensitivity, specificity, PPV, and NPV reached 88.9%, 90.2%, 88%, 84.1%, and 92.7%, respectively, with respect to final RT-PCR test. The mean delay for CT reports was three times shorter than for RT-PCR results (187 ? 148 min versus 573 ? 327 min, p < 0.0001).
Conclusion: During COVID-19 epidemic phase, chest CT is a rapid and most probably an adequately reliable tool to refer patients requiring hospitalization to the COVID+ or COVID- hospital units, when response times for virological tests are too long.
Key points: • In a large university hospital in Lyon, France, the accuracy, sensitivity, specificity, PPV, and NPV of chest CT for COVID-19 reached 88.9%, 90.2%, 88%, 84.1%, and 92.7%, respectively, using RT-PCR as standard of reference. • The mean delay for CT reports was three times shorter than for RT-PCR results (187 ? 148 min versus 573 ? 327 min, p < 0.0001). • Due to high accuracy of chest CT for COVID-19 and shorter time for CT reports than RT-PCR results, chest CT can be used to orient patients suspected to be positive towards the COVID+ unit to decrease congestion in the emergency departments.
Keywords: Coronavirus; Diagnostic imaging; Emergency medicine; Sensitivity and specificity; Tomography, X-ray.
. 2020 Aug 19.
doi: 10.1007/s00330-020-07154-4. Online ahead of print.
Chest CT for rapid triage of patients in multiple emergency departments during COVID-19 epidemic: experience report from a large French university hospital
Victoria Ducray[SUP] 1 [/SUP], Anna Sesilia Vlachomitrou[SUP] 2 [/SUP], Maude Bouscambert-Duchamp[SUP] 3 4 [/SUP], Salim Si-Mohamed[SUP] 5 6 7 [/SUP], Sylvain Gouttard[SUP] 1 [/SUP], Adeline Mansuy[SUP] 1 [/SUP], Florian Wickert[SUP] 8 [/SUP], Alain Sigal[SUP] 9 [/SUP], Alexandre Gaymard[SUP] 3 4 [/SUP], Fran?ois Talbot[SUP] 10 [/SUP], Catherine Michel[SUP] 10 [/SUP], Thomas Perpoint[SUP] 11 [/SUP], Jean-Baptiste Pialat[SUP] 1 8 [/SUP], Olivier Rouviere[SUP] 1 12 [/SUP], Laurent Milot[SUP] 1 [/SUP], Fran?ois Cotton[SUP] 1 8 [/SUP], Philippe Douek[SUP] 1 8 [/SUP], Muriel Rabilloud[SUP] 13 [/SUP], Loic Boussel[SUP] 1 8 [/SUP], COVID-Outcomes-HCL Consortium
Collaborators, Affiliations
- PMID: 32813105
- DOI: 10.1007/s00330-020-07154-4
Abstract
Objectives: To assess the diagnostic performances of chest CT for triage of patients in multiple emergency departments during COVID-19 epidemic, in comparison with reverse transcription polymerase chain reaction (RT-PCR) test.
Method: From March 3 to April 4, 2020, 694 consecutive patients from three emergency departments of a large university hospital, for which a hospitalization was planned whatever the reasons, i.e., COVID- or non-COVID-related, underwent a chest CT and one or several RT-PCR tests. Chest CTs were rated as "Surely COVID+," "Possible COVID+," or "COVID-" by experienced radiologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the final RT-PCR test as standard of reference. The delays for CT reports and RT-PCR results were recorded and compared.
Results: Among the 694 patients, 287 were positive on the final RT-PCR exam. Concerning the 694 chest CT, 308 were rated as "Surely COVID+", 34 as "Possible COVID+," and 352 as "COVID-." When considering only the "Surely COVID+" CT as positive, accuracy, sensitivity, specificity, PPV, and NPV reached 88.9%, 90.2%, 88%, 84.1%, and 92.7%, respectively, with respect to final RT-PCR test. The mean delay for CT reports was three times shorter than for RT-PCR results (187 ? 148 min versus 573 ? 327 min, p < 0.0001).
Conclusion: During COVID-19 epidemic phase, chest CT is a rapid and most probably an adequately reliable tool to refer patients requiring hospitalization to the COVID+ or COVID- hospital units, when response times for virological tests are too long.
Key points: • In a large university hospital in Lyon, France, the accuracy, sensitivity, specificity, PPV, and NPV of chest CT for COVID-19 reached 88.9%, 90.2%, 88%, 84.1%, and 92.7%, respectively, using RT-PCR as standard of reference. • The mean delay for CT reports was three times shorter than for RT-PCR results (187 ? 148 min versus 573 ? 327 min, p < 0.0001). • Due to high accuracy of chest CT for COVID-19 and shorter time for CT reports than RT-PCR results, chest CT can be used to orient patients suspected to be positive towards the COVID+ unit to decrease congestion in the emergency departments.
Keywords: Coronavirus; Diagnostic imaging; Emergency medicine; Sensitivity and specificity; Tomography, X-ray.