Assigning computed tomography involvement score in COVID-19 patients: prognosis prediction and impact on management

Abstract

Objective: Chest CT can provide a simple quantitative assessment of the extent of the parenchymal opacities in COVID-19 patients. In this study, we postulate that CT findings can be used to ascertain the overall disease burden and predict the clinical outcome. Methods: In this prospective study undertaken from March 28, 2020, until May 20, 2020, 142 patients with CT features suggestive of viral pneumonia, and positive RT-PCR for COVID-19 were enrolled. A dedicated spiral CT scanner was used for all COVID-19 suspects. CT features were reported as typical, indeterminate, or atypical for COVID-19 pneumonia. A CT involvement score (CT-IS) was given to each scan and assigned mild, moderate, or severe category depending on the score range. The patients were followed up for at least 15 days. Results: Ground glass opacity was present in 100% of the patients. There was a significant association between CT-IS and the final outcome of the patients. A statistically significant increasing trend of mortality and requirement of critical medical attention was observed with the rising value of CT-IS in COVID-19. Conclusion: The severe CT-IS score group has a high mortality. The CT-IS score could be valuable in predicting clinical outcome and could also be useful in triage of patients needing hospital admission. In situations where healthcare resources are limited, and patient load high, a more careful approach for patients with higher CT-IS scores could be indispensable. Advances in knowledge: CT-IS is a simple quantitative method for assessing the disease burden of COVID-19 cases. It can be invaluable in places with limited resources and high patient load to segregate patients requiring critical medical attention.

New challenges for management of COVID-19 patients: Analysis of MDCT based “Automated pneumonia analysis program”

“…CRP, Neutrophil/ Lymphocyte, troponin levels were found as positive predictors of clinical worsening whereas higher D-dimer levels were correlated with mortality status [22,28,29]. Like other previous studies, our hypothesis was that automated diagnosis and quantification programs for pneumonia are valuable in predicting clinical outcome, helps physicians in triaging patients and to start appropriate treatment as soon as possible [13,22,23].…”

“…Like other previous studies, our hypothesis was that automated diagnosis and quantification programs for pneumonia are valuable in predicting clinical outcome, helps physicians in triaging patients and to start appropriate treatment as soon as possible [ 13 , 22 , 23 ].…”

“…While different scoring programs are defined by different manufacturers, the main result from different studies is similar [ 13 , 22 , 23 ].…”

“…Management of the patients with COVID-19 pneumonia is highly dependent on the fast diagnosis and revealing of the severity of lung involvement. Chest radiographs can cause false negativeness for early abnormalities of the COVID-19 pneumonia and also might not be enough to reveal the disease severity [ 4 , 13 , 23 , 25 ]. On the other hand, RT-PCR test results take a while and false negativeness is another issue.…”

“…On the other hand, RT-PCR test results take a while and false negativeness is another issue. Moreover, it is well known that chest CT findings of COVID-19 pneumonia has similarities with and cannot be distinguished from other viral-atypical pneumonias [ 23 , 26 , 27 ]. In the conditions of a pandemic, chest CT scan has a unique place as the main, fastest and most reliable diagnostic tool available to diagnose and to reveal the disease severity of COVID-19 pneumonia.…”