CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study
CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study
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DOI：
10.1371/journal.pone.0235844
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发表时间：
2020-07-09
期刊：
影响因子：
3.7
通讯作者：
Stassen, Patricia M.
中科院分区：
文献类型：
--
作者：
Gietema, Hester A.;Zelis, Noortje;Stassen, Patricia M.
早期鉴别急诊科（ED）患者是否患有冠状病毒病（COVID-19）非常重要。胸部CT扫描可能有助于COVID-19的早期诊断。以RT-PCR为参比标准，探讨CT对SARS-CoV-2的诊断准确性，并探讨两种检测结果不一致的原因。方法在荷兰进行的这项前瞻性单中心研究中，所有成年有症状的ED患者在到达ED时都进行了CT扫描和RT-PCR检测。将CT结果与PCR检测结果进行比较。计算诊断准确率。采用出院诊断方法调查不一致的结果。结果2020年3月13日至3月24日，纳入有症状ED患者193例。PCR阳性占43.0%，CT阳性占56.5%，敏感性89.2%，特异性68.2%，似然比(LR)+ 2.81, LR- 0.16。高危肺炎（CURB-65评分>= 3,n = 17, 100%）和脓毒症（SOFA评分>= 2,n = 137, 95.5%）患者的敏感性更高。在CT可疑、RT-PCR阴性的35例患者（31.8%）中，9例患者有其他呼吸道病毒病原体，7例患者被认为可能为COVID-19。9名CT无可疑且PCR阳性的患者中有1名在扫描前48小时内出现症状。胸部CT在有症状ED患者中的准确性很高，但作为单一的诊断检查，CT不能安全地诊断或排除COVID-19。然而，CT可以作为一种快速的工具，将患者分为“可能阳性”和“可能阴性”两组。
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.