Chest CT: A valuable tool in discrimination of covid-19 pneumonia, community acquired pneumonia and the other pathologies in slow epidemic phase
Abstract
Aim: SARS-CoV-2 infection manifests like COVID-19 pneumonia, computed tomography (CT) has been reported as its valuable imaging. Frequent arguments against are discussed: the problem of the possible further spread of the infection to medical staff and/or other patients, and also insufficient SARS-CoV-2 detectability based solely on CT.
The aim of the study was to examine the usefulness of CT for personalized, precision and predictive diagnostics of COVID-19-suspected. Method: Chest CT was performed due to suspected COVID-19 pneumonia in 310 patients during slow epidemic in Czech Republic, during March and April 2020.
All patients underwent sampling for RT-PCR to confirm SARS-CoV-2 viral presence. When all RT-PCR tests had been completed and after one week of follow-up, the assessment of the sensitivity, specificity, positive and negative predictive value, and accuracy were calculated, a role of the discrimination using leukocytosis in suspected chest CT findings was evaluated respectively.
One-weekfollow-up was performed to assess the readmission of the patient, and/or the COVID-19 transmission within patients or staff. Results: The overall sensitivity of 93.75%, specificity of 94.60%, positive predictive value of 66.67%, negative predictive value of 99.25%, and accuracy 94.52 were reached; adding leukocytosis in suspected cases, specificity of 99.64%, positive predictive value of 96.77%, negative predictive value of 99.28%, and accuracy 99.03% were improved respectively.
Only one re-admission with COVID-19 in formerly CT-negative was recorded. There were no noted SARS-CoV-2 transmission neither patient-to-patient, nor patient-to-staff.
Conclusion: The high negative predictive value of chest CT significantly contributed to the early identification of a large group patients with low risk for COVID-19, thus allowing them to be safely admitted outside the reserved COVID-19 units, the additional strength lies in the ability to identify an alternative non-COVID-19 diagnosis to explain the patients' clinical symptoms. The CT based approach is enabling personalized, precise and predictive approach to COVID-19 pneumonia detection. (C) 2020, Galen s.r.o.
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