Assessment of a Diagnostic Strategy Based on Chest Computed Tomography in Patients Hospitalized for COVID-19 Pneumonia: an observational study
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Abstract
Objectives
To assess the relevance of a diagnostic strategy for COVID-19 based on chest computed tomography (CT) in patients with hospitalization criteria.
Setting
Observational study with retrospective analysis in a French emergency department (ED).
Participants and intervention
From March 3 to April 2, 2020, 385 adult patients presenting to the ED for suspected COVID-19 underwent an evaluation that included history, physical examination, blood tests, real-time reverse transcription-polymerase chain reaction (RT-PCR) and chest CT. When the time-interval between chest CT and RT-PCR assays was longer than 7 days, patients were excluded from the study. Only patients with hospitalization criteria were included. Diagnosis accuracy was assessed using the sensitivity and specificity of RT-PCR.
Outcomes
Sensitivity and specificity of RT-PCR, chest CT (also accompanied by lymphopenia) were measured and were also analyzed by subgroups of age and sex.
Results
Among 377 included subjects, RT-PCR was positive in 36%, while chest CT was compatible with a COVID-19 diagnosis in 59%. In the population with positive RT-PCR, there were more men (55% vs 37%, p=0.015), a higher frequency of reticular and, or, interlobular septal thickening (53% vs 31%, p=0.02) as well as a higher frequency of bilateral lesion distribution (98% vs 86%, p=0.01) compared to the population with negative RT-PCR. The proportion of lymphopenia was higher in men vs women (47% vs 39%, p=0.03) and varies between patients >80 versus 50-80 and p<0.001).
Using CT as reference, RT-PCR obtained a sensitivity of 61%, specificity of 93%. There was a significant difference between CT and RT-PCR diagnosis performance (p < 0.001). When CT was accompanied by lymphopenia, sensitivity and specificity of RT-PCR were respectively 71% and 94%. CT abnormalities and lymphopenia provided diagnosis in 29% of patients with negative PCR.
Conclusions
Chest CT had a superior yield than RT-PCR in COVID-19 hospitalized patients, especially when accompanied by lymphopenia.
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SciScore for 10.1101/2020.06.29.20140129: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: This study was approved by a local Ethics Committee and the data treatment was approved by the National Commission for Liberties and Data Protection (CNIL) (number 2217103 v 0). Randomization not detected. Blinding Image analysis: All CT images were independently reviewed by two radiologists (AC and ACK with 13 and 15 years of experience in interpreting CT images, respectively), blinded to the RT-PCR results and to the first interpretation. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged …
SciScore for 10.1101/2020.06.29.20140129: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: This study was approved by a local Ethics Committee and the data treatment was approved by the National Commission for Liberties and Data Protection (CNIL) (number 2217103 v 0). Randomization not detected. Blinding Image analysis: All CT images were independently reviewed by two radiologists (AC and ACK with 13 and 15 years of experience in interpreting CT images, respectively), blinded to the RT-PCR results and to the first interpretation. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:While our study provided an overview of real-life professional practices, time and resources management during a health crisis, it has some limitations. First, the prevalence of the disease is unknown. In absence of mass screening, we believe that it is much higher than announced, which may change positive and negative predictive values and impacts the clinical decision.[16] Secondly, sensitivity and specificity values can be subject to bias, which we aimed to reduce by selecting patients with hospitalization criteria. On the other hand, we are aware that our population was not representative of all COVID-19 patients. Finally, because our study was observational, some data are missing.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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