• English
    • español
    • português (Brasil)
  • English 
    • English
    • español
    • português (Brasil)
  • Login
View Item 
  •   COVID-19
  • Resources in English
  • Technical documents and research evidence on COVID-19
  • View Item
  •   COVID-19
  • Resources in English
  • Technical documents and research evidence on COVID-19
  • View Item
JavaScript is disabled for your browser. Some features of this site may not work without it.

Diagnostic power of chest CT for COVID-19: to screen or not to screen

 
Thumbnail
Date
2020-05-24
Author
De Smet, Kristof et al.
Metadata
Show full item record
Abstract
Background: chest CT is increasingly used for COVID-19 screening in healthcare systems with limited SARS-CoV-2 PCR capacity. Its diagnostic value was supported by studies with methodological concerns and its use is controversial. Here we investigated its potential to diagnose COVID-19 in symptomatic patients and to screen asymptomatic patients in a prospective study with minimal selection bias. Methods: From March 19, 2020 to April 20, 2020 we performed parallel SARS-CoV-2 PCR and CT with categorization of COVID-19 suspicion by CO-RADS, in 859 patients with COVID-19 symptoms and 1138 controls admitted to the hospital for COVID-19 unrelated medical urgencies. CT-CORADS was categorized on a 5-point scale from 1 (very low suspicion) to 5 (very high suspicion). AUC under ROC curve were calculated in symptomatic versus asymptomatic patients to predict positive SARS-CoV-2 positive PCR and likelihood ratios for each CO-RADS score were used for rational selection of diagnostic thresholds. Findings: CT-CORADS had significant (P<0.0001) diagnostic power in both symptomatic (AUC=0.891) and asymptomatic (AUC=0.700) patients hospitalized during SARS-CoV-2 peak prevalence. In symptomatic patients (41.7% PCR+), CO-RADS ≥ 3 detected positive PCR with high sensitivity (89.1%) and 72.5% specificity. In asymptomatic patients (5.3% PCR+), a CO-RADS score ≥ 3 detected SARS-CoV-2 infection with low sensitivity (45.0%) but high specificity (88.8%). Interpretation: CT-CORADS has meaningful diagnostic power in symptomatic patients, supporting its application for time-sensitive triage. Sensitivity in asymptomatic patients is insufficient to justify its use as screening approach. Incidental detection of CO-RADS ≥ 3 in asymptomatic patients should trigger reflex testing for respiratory pathogens.
URI
https://doi.org/10.1101/2020.05.18.20097444
Collections
  • Technical documents and research evidence on COVID-19

Browse

AllCommunities & CollectionsBy Issue DateAuthorsTitlesCategorySubjectsThis CollectionBy Issue DateAuthorsTitlesCategorySubjects

My Account

LoginRegister

Pan American Health Organization
World Health Organization. Regional Office for the Americas
525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America

Content Disclaimer (Important notes about the material)

Links

  • WHO International Clinical Trial Registry Platform (ICTRP)
  • WHO Coronavirus disease R&D Blueprint
  • WHO Database of Publications on Coronavirus Disease
  • PAHO Coronavirus Disease
  • PAHO/BIREME Windows of Knowledge COVID-19
  • Evidence aid Coronavirus (COVID-19) resources

  • PAHO Digital Library (IRIS PAHO)
  • Virtual Health Library (VHL)
  • Global Index Medicus (GIM)