CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study.
<h4>Introduction</h4>Early 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-...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2020-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0235844&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850043165919150080 |
|---|---|
| author | Hester A Gietema Noortje Zelis J Martijn Nobel Lars J G Lambriks Lieke B van Alphen Astrid M L Oude Lashof Joachim E Wildberger Irene C Nelissen Patricia M Stassen |
| author_facet | Hester A Gietema Noortje Zelis J Martijn Nobel Lars J G Lambriks Lieke B van Alphen Astrid M L Oude Lashof Joachim E Wildberger Irene C Nelissen Patricia M Stassen |
| author_sort | Hester A Gietema |
| collection | DOAJ |
| description | <h4>Introduction</h4>Early 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.<h4>Methods</h4>In 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.<h4>Results</h4>Between March 13th and March 24th 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.<h4>Discussion</h4>The 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. |
| format | Article |
| id | doaj-art-e80533fae6754e549865fa77f640fe78 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-e80533fae6754e549865fa77f640fe782025-08-20T02:55:17ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01157e023584410.1371/journal.pone.0235844CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study.Hester A GietemaNoortje ZelisJ Martijn NobelLars J G LambriksLieke B van AlphenAstrid M L Oude LashofJoachim E WildbergerIrene C NelissenPatricia M Stassen<h4>Introduction</h4>Early 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.<h4>Methods</h4>In 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.<h4>Results</h4>Between March 13th and March 24th 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.<h4>Discussion</h4>The 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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0235844&type=printable |
| spellingShingle | Hester A Gietema Noortje Zelis J Martijn Nobel Lars J G Lambriks Lieke B van Alphen Astrid M L Oude Lashof Joachim E Wildberger Irene C Nelissen Patricia M Stassen CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study. PLoS ONE |
| title | CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study. |
| title_full | CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study. |
| title_fullStr | CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study. |
| title_full_unstemmed | CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study. |
| title_short | CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study. |
| title_sort | ct in relation to rt pcr in diagnosing covid 19 in the netherlands a prospective study |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0235844&type=printable |
| work_keys_str_mv | AT hesteragietema ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy AT noortjezelis ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy AT jmartijnnobel ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy AT larsjglambriks ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy AT liekebvanalphen ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy AT astridmloudelashof ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy AT joachimewildberger ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy AT irenecnelissen ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy AT patriciamstassen ctinrelationtortpcrindiagnosingcovid19inthenetherlandsaprospectivestudy |