The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society
The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society
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DOI：
10.1148/radiol.2020201365
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发表时间：
2020-07-01
期刊：
影响因子：
19.7
通讯作者：
Leung, Ann N.
中科院分区：
文献类型：
--
作者：
Rubin, Geoffrey D.;Ryerson, Christopher J.;Leung, Ann N.
2020年前3个月，全球确诊病例超过90万例，死亡近5万人，冠状病毒病2019(新冠肺炎)大流行已成为前所未有的医疗危机。新冠肺炎的传播具有异质性，导致一些地区出现零星传播，新冠肺炎住院患者相对较少，其他地区则出现社区传播，导致绝大多数重症病例。对于这些地区，由于诊断检测、医院病床、呼吸机和因个人防护设备短缺而病情加重的医护人员的严重资源限制，卫生保健的提供受到了干扰和损害。虽然轻度病例类似于常见的上呼吸道病毒感染，但随着疾病的发展，呼吸功能障碍成为发病率和死亡率的主要来源。胸部摄影和CT是肺部疾病诊断和治疗的关键工具，但它们在新冠肺炎治疗中的作用尚未考虑到呼吸系统疾病的严重性、预测概率、疾病进展的风险因素和关键资源限制等多变量背景下。为了解决这一不足，一个主要由来自10个国家和地区的放射科医生和肺科医生组成的多学科小组，在不同的医疗保健环境中评估了三种情况下成像的实用性，这些情景代表不同的风险因素、社区条件和资源限制。14个关键问题，对应于三个场景中的11个决策点和三个额外的临床情况，由专家小组根据胸部成像预期提供的信息的预期价值进行评级。对结果进行汇总，得出五项主要建议和三项补充建议，旨在指导医生在处理新冠状病毒感染时使用胸部X光和CT。(C)RSNA，2020；美国胸科医师学会，由Elsevier Inc.出版。
With more than 900 000 confirmed cases worldwide and nearly 50 000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous,resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and healthcare workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management,but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management ofCOVID-19. (C) RSNA, 2020; American College of Chest Physicians, published by Elsevier Inc.