Chest CT for rapid triage of patients in multiple emergency departments during COVID-19 epidemic: experience report from a large French university hospital

Ducray, Victoria; Vlachomitrou, Anna Sesilia; Bouscambert‐Duchamp, Maude; Si‐Mohamed, Salim; Gouttard, Sylvain; Mansuy, Adeline; Wickert, Florian; Talbot, François; Michel, Catherine; Perpoint, Thomas; Pialat, Jean‐Baptiste; Rouvière, Olivier; Milot, Laurent; Cotton, François; Douek, Philippe; Rabilloud, Muriel; Boussel, Loîc; Argaud, Laurent; Aubrun, Frédéric; Bohé, Julien; Bonnefoy, Marc; Chapurlat, Roland; Chassard, D.; Chidiac, Christian; Chuzeville, Michel; Confavreux, Cyrille; Couraud, Sébastien; Devouassoux, Gilles; Durieu, I.; Fellahi, Jean-Luc; Gaujard, Sylvain; Gaymard, Alexandre; Hot, A.; Krolak‐Salmon, Pierre; Lantelme, Pierre; Lina, Bruno; Luauté, Jacques; Lukaszewicz, Anne Claire; Martin-Gaujard, Géraldine; Mornex, J. F.; Potinet, Véronique; Rimmelé, Thomas; Rode, G.; Sève, Frederic Pascal; Sigal, Alain; Zoulim, Fabien

doi:10.1007/s00330-020-07154-4

Cited by 33 publications

(33 citation statements)

References 23 publications

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“…Consequently, the exact frequency of normal chest CT in a homogeneous and large cohort of symptomatic COVID-19 patients as well as the outcome of these patients remains unknown. As chest CT can be used for triage of symptomatic patients suspected of COVID-19 [11][12][13], knowing the frequency and the impact of a normal chest CT at presentation in this population would be valuable to optimize their management and care.…”

Section: Introductionmentioning

confidence: 99%

Normal chest CT in 1091 symptomatic patients with confirmed Covid-19: frequency, characteristics and outcome

et al. 2021

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Objective Frequency of normal chest CT in symptomatic COVID-19 patients as well as the outcome of these patients remains unknown. The objectives of this work were to assess the incidence of initially normal chest CT in a cohort of consecutive confirmed COVID-19 patients with respiratory symptoms and to compare their clinical characteristics and their outcome to matched patients with typical COVID-19 lesions at initial CT. Methods From March 6 th to April 22 nd , all consecutive adult patients referred to the COVID-19 clinic of our Emergency Department were retrospectively analyzed. Each patient with a positive SARS-CoV-2 RT-PCR and a normal initial chest CT after second reading was 1:1 matched based on sex, age and date of CT acquisition to a patient with positive RT-PCR and initial chest CT with typical COVID-19 lesions. Clinical data, laboratory results and outcomes (major being mechanical ventilation and/ or death) were compared between both groups, using Wilcoxon signed-rank test, McNemar's chi-squared test and/or exact McNemar's test where appropriate. Results Fifty-seven chest CT out of 1091 (5.2%, 95% CI 4.0-6.7) in symptomatic patients with positive RT-PCR were normal, with a median onset of symptoms of 4.5 days (IQR [1.25-10.25]). After a median follow-up of 43 days, death and/or mechanical ventilation occurred in 3 patients (5.3%) in the study group, versus 11 (19.3%) in the control group (p = 0.011). Conclusions Normal initial chest CT occurred in 5.2% of symptomatic confirmed COVID-19 cases in our cohort. While better than those with abnormal chest CT, outcome was not entirely benign with 5.3% death and/or mechanical ventilation. Key Points• In a cohort of 1091 symptomatic COVID-19 patients, initial chest CT was normal in 5.2% of cases.• Normal chest CT in confirmed COVID-19 is frequent even when onset of symptoms is greater than 3 days.• The outcome of COVID-19 patients with initial normal chest CT, while better than those with abnormal CT, was not entirely benign with 5.3% death and/or mechanical ventilation. Keywords Diagnostic imaging . Multidetector computed tomography . Lung diseases . COVID-19 . Reverse transcriptase polymerase chain reaction Abbreviations CT Computed tomography ED Emergency department ICU Intensive care unit RT-PCR Reverse transcriptase polymerase chain reaction * Mickaël Ohana

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Section: Introductionmentioning

confidence: 99%

Normal chest CT in 1091 symptomatic patients with confirmed Covid-19: frequency, characteristics and outcome

et al. 2021

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“…Our study revealed that in the first week of disease course, CT was sensitive to the COVID-19 with initial negative RT-PCR, and subsequent RT-PCR result turned positive while chest CT mostly demonstrated progression including more lung lobes involvement and higher severity score. RT-PCR has been used as the gold standard so far for COVID-19 diagnosis 10 , but this test does have false negatives 17 - 19 . Patients with initial negative RT-PCR could infect other people especially when Chest CT indicated positive who could be covert infection.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with initial negative RT-PCR may be covert infections who may not be identified and consequently could continue to spread this disease and chest CT scans are emerging as a useful tool in the screening of COVID-19. High sensitivity (67-100%) and relatively low specificity (25-90%) was reported for the CT scans, while the sensitivity of RT-PCR was reported to be modest (53-88%) 17 - 19 . The clinical and radiological manifestations in COVID-19 cases with negative RT-PCR results have been preliminarily discovered by Guanjing Lang et al 15 , which were just a briefly description without statistical analysis due to small sample size (8 patients).…”

Section: Introductionmentioning

confidence: 96%

Chest CT Imaging Features of Typical Covert COVID-19 Cases

Dai¹,

Ouyang²,

Yang³

et al. 2021

Int. J. Med. Sci.

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Purpose: To analyze the chest CT imaging findings of patients with initial negative RT-PCR and to compare with the CT findings of the same sets of patients when the RT-PCR turned positive for SARS-CoV-2 a few days later. Materials and methods: A total of 32 patients (8 males and 24 females; 52.9±7years old) with COVID-19 from 27 January and 26 February 2020 were enrolled in this retrospective study. Clinical and radiological characteristics were analyzed. Results: The median period (25%, 75%) between initial symptoms and the first chest CT, the initial negative RT-PCR, the second CT and the positive RT-PCR were 7(4.25,11.75), 7(5,10.75), 15(11,23) and 14(10,22) days, respectively. Ground glass opacities was the most frequent CT findings at both the first and second CTs. Consolidation was more frequently observed on lower lobes, and more frequently detected during the second CT (64.0%) with positive RT-PCR than the first CT with initial negative RT-PCR (53.1%). The median of total lung severity score and the number of lobes affected had significant difference between twice chest CT (P=0.007 and P=0.011, respectively). Conclusion: In the first week of disease course, CT was sensitive to the COVID-19 with initial negative RT-PCR. Throat swab test turned positive while chest CT mostly demonstrated progression.

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“…[ 37 ] CT is a fast, adequate, and reliable diagnostic modality to refer patients with COVID-19 for hospitalization when the response of PT-PCR is late. [ 38 ]…”

Section: Reviewmentioning

confidence: 99%

Frequent clinical and radiological manifestations of the Novel SARS-CoV-2: A review article

Alshoabi

Alhazmi

Abdulaal

et al. 2021

J Family Med Prim Care

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Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by the novel “severe acute respiratory syndrome coronavirus-2” (SARS-CoV-2) and is rapidly spreading worldwide. This review is designed to highlight the most common clinical features and computed tomography (CT) signs of patients with COVID-19 and to elaborate the most significant signs indicative of COVID-19 diagnosis. This review involved five original articles with both clinical and radiological features of COVID-19 published during Jan and Mar 2020. In this review, the most frequent symptoms of COVID-19 were fever and cough. Myalgia, fatigue, sore throat, headache, diarrhea, and dyspnea were less common manifestations. Nausea and vomiting were rare. Ground-glass opacity (GGO) was the most common radiological finding on CT, and mixed GGO with consolidation was reported in some cases. In addition, elevated C-reactive protein and lymphopenia are the pertinent laboratory findings of COVID-19. CT is an effective and important imaging tool for both diagnosis and follow-up COVID-19 patients with varied features, duration, and course of the disease. Bilateral GGOs, especially in the periphery of the lungs with or without consolidation, are the hallmark of COVID-19.

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Chest CT for rapid triage of patients in multiple emergency departments during COVID-19 epidemic: experience report from a large French university hospital

Cited by 33 publications

References 23 publications

Normal chest CT in 1091 symptomatic patients with confirmed Covid-19: frequency, characteristics and outcome

Normal chest CT in 1091 symptomatic patients with confirmed Covid-19: frequency, characteristics and outcome

Chest CT Imaging Features of Typical Covert COVID-19 Cases

Frequent clinical and radiological manifestations of the Novel SARS-CoV-2: A review article

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