A systematic review of CT chest in COVID‐19 diagnosis and its potential application in a surgical setting

Abstract

Aim The aim of this work was to investigate the sensitivity and utility of CT of the chest in diagnosing active SARS-Cov-2 (COVID-19) infection, and its potential application to the surgical setting. Method A literature review was conducted using Google Scholarâ and MEDLINEâ/PubMedâ to identify current available evidence regarding the sensitivity of CT chest compared with RT-PCR for the diagnosis of COVID-19-positive patients. GRADE criteria and the QUADAS 2 tool were used to assess the level of evidence. Results A total of 20 articles were identified that addressed the question of sensitivity of CT for diagnosis of symptomatic and asymptomatic COVID-19-positive patients. Overall sensitivity of CT scan ranged from 57%-100% for symptomatic and 46%-100% for asymptomatic COVID-19 patients, while that of RT-PCR ranged from 39%-89%. CT chest was a better diagnostic modality and capable of detecting active infection earlier in the time course of infection than RT-PCR in symptomatic patients. In asymptomatic patients, disease prevalence seems to play a role in the positive predictive value. Minimal evidence exists regarding the sensitivity of CT in patients who are asymptomatic. Conclusions In surgical patients, CT chest should be considered as an important adjunct for detection of COVID-19 infection in patients who are symptomatic with negative RT-PCR prior to any operation. For surgical patients who are asymptomatic, there is insufficient evidence to recommend routine preoperative CT chest for COVID-19 screening.

The time course of chest CT lung changes in COVID-19 patients from onset to discharge

“…In this retrospective study, we found that the total lesion score of CT in severe patients was significantly higher than non-sever patients, which was consistent with previous studies showing that severe patients had a larger lung lesion area than non-severe cases [ [14] , [15] , [16] ]. This might be due to more severe bilateral pulmonary infiltrates at the peak of the disease in severe cases.…”

EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology

“… When dealing with positive tested COVID-19 patients, hospital planning and organization should ideally consider if surgery is emergent or elective [click here]. We recommend that in cardiac patients with clinical symptoms suggestive of infection with SARS-CoV 2 (e.g., cough, fever) and a negative PCR test result, a computerized chest tomography (CT) is performed ( 12 ). Suppose surgery is urgent and necessary in a patient with suspected or confirmed infection, before proceeding to the operating theatre.…”

Chest Computed Tomography for SARS-CoV-2 Screening before Bariatric and Metabolic Surgery during the COVID-19 Pandemic

“…Therefore, to enable a safe bariatric surgery program, an adequate diagnostic method to identify patients in the acute phase of COVID-19 proves critical [15]. The most commonly used diagnostic test worldwide for SARS-CoV-2 infection is RT-PCR; however, this method has failed to recognize more than 29% of asymptomatic patients [16].…”