dc.contributor.author | De Smet, Kristof et al. | |
dc.date.accessioned | 2020-06-08T20:54:14Z | |
dc.date.available | 2020-06-08T20:54:14Z | |
dc.date.issued | 2020-05-24 | |
dc.identifier.uri | https://doi.org/10.1101/2020.05.18.20097444 | en_US |
dc.identifier.uri | https://hdl.handle.net/20.500.12663/1722 | |
dc.description.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. | en_US |
dc.language | English | en_US |
dc.subject | COVID-19 | en_US |
dc.subject | Coronavirus | en_US |
dc.subject | Infectious Diseases | en_US |
dc.subject | Betacoronavirus | en_US |
dc.subject | Delivery of Health Care | en_US |
dc.subject | Methods | en_US |
dc.subject | Polymerase Chain Reaction | en_US |
dc.title | Diagnostic power of chest CT for COVID-19: to screen or not to screen | en_US |
eihealth.country | Global (WHO/OMS) | en_US |
eihealth.category | Clinical characterization and management | en_US |
eihealth.type | Published Article | en_US |
eihealth.maincategory | Save Lives / Salvar Vidas | en_US |
dc.relation.ispartofjournal | medRxiv | en_US |