CT in relation to RT-PCR in diagnosing COVID-19 in the Netherlands: a prospective study

Gietema, Hester A.; Zelis, Noortje; Nobel, J. Martijn; Lambriks, Lars; Alphen, Lieke B. van; Lashof, Astrid M. L. Oude; Wildberger, Joachim E.; Nelissen, Irene C.

doi:10.1101/2020.04.22.20070441

Cited by 26 publications

(47 citation statements)

References 25 publications

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“…The sample sizes ranged from 18 to 5,700 COVID-19 confirmed cases (median 90; interquartile range -IQR= 46.5 to 204). Twelve studies focused on the estimation of diagnostic test accuracy, including populations with suspected COVID-19 at the beginning of the study (33, 36-38, 40, 43, 45, 46, 50, 56, 64). The remaining studies reported information from case series, most of which included confirmed cases of COVID-19 at the beginning of the study (34, 35, 41, 42, 44, 47-49, 51-55, 57-63, 65, 66).…”

Section: Resultsmentioning

confidence: 99%

False-Negative Results of Initial Rt-PCR Assays for Covid-19: A Systematic Review

Arévalo-Rodríguez

Buitrago-Garcia

Simancas‐Racines

et al. 2020

Preprint

355

372

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Background: Cases with negative reverse transcription-polymerase chain reaction (RT-PCR) results at initial testing for suspicion of SARS-CoV-2 infection, and found to be positive in a subsequent test, are considered as RT-PCR false-negative cases. False-negative cases have important implications for COVID-19 management, isolation, and risk of transmission. We aimed to review and critically appraise evidence about the proportion of RT-PCR false-negatives at initial testing for COVID-19. Methods: We performed a systematic review and critical appraisal of literature with high involvement of stakeholders in the review process. We searched on MEDLINE, EMBASE, LILACS, the WHO database of COVID-19 publications, the EPPI-Centre living systematic map of evidence about COVID-19, and the living systematic review developed by the University of Bern (ISPM). Two authors screened and selected studies according to the eligibility criteria and collected data of included studies (no-independent verification). Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. We calculated the false-negative proportion with the corresponding 95% CI using a multilevel mixed-effect logistic regression model using STATA 16. Certainty of the evidence about false-negative cases was rated using the GRADE approach for tests and strategies. The information is current up to 6 April 2020. Findings: Five studies enrolling 957 patients were included. All studies were affected by several biases and applicability concerns. Pooled estimation of false-negative proportion was 0.085 (95% CI= 0.034 to 0.196; tau-squared = 1.08; 95% CI= 0.27 to 8.28; p<0.001); however, this estimation is highly affected by unexplained heterogeneity, and its interpretation should be avoided. The certainty of the evidence was judged as very low, due to the risk of bias, indirectness, and inconsistency issues. Conclusions: The collected evidence has several limitations, including risk of bias issues, high heterogeneity, and concerns about its applicability. Nonetheless, our findings reinforce the need for repeated testing in patients with suspicion of SARS-Cov-2 infection given that up to 29% of patients could have an initial RT-PCR false-negative result. Systematic review registration: Protocol available on OSF website: https://osf.io/gp38w/

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Section: Resultsmentioning

confidence: 99%

False-Negative Results of Initial Rt-PCR Assays for Covid-19: A Systematic Review

Arévalo-Rodríguez

Buitrago-Garcia

Simancas‐Racines

et al. 2020

Preprint

355

372

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“…The two prospective studies included in this review were by Caruso et al . and Gietema et al [33,34]. Caruso et al .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Other studies have used these inclusion criteria as well. [20] If we apply the RISE UP score only to the patients that were confirmed with PCR, we found similar discriminatory values (AUC 0.76 (95% CI: 0.71-0.80) for 30-day mortality). Next, our study was limited to patients admitted to the hospital.…”

Section: Discussionmentioning

confidence: 65%

Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department, a retrospective study

Dam

Zelis

Twist

et al. 2020

Preprint

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ObjectiveTo mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed RISE UP score has very good discriminatory value with respect to short-term mortality in older patients in the emergency department (ED). It consists of six items: age, abnormal vital signs, albumin, blood urea nitrogen (BUN), lactate dehydrogenase (LDH), and bilirubin. We hypothesized that the RISE UP score could have discriminatory value with regard to 30-day mortality in ED patients with COVID-19.SettingTwo EDs of the Zuyderland Medical Centre (MC), secondary care hospital in the Netherlands.ParticipantsThe study sample consisted of 642 adult ED patients diagnosed with COVID-19 between March 3rd until May 25th 2020. Inclusion criteria were: 1) admission to the hospital with symptoms suggestive of COVID-19, and 2) positive result of the polymerase chain reaction (PCR), or (very) high suspicion of COVID-19 according to the chest computed tomography (CT) scan.OutcomePrimary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).ResultsWithin 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value with respect to 30-day mortality (AUC 0.77, 95% CI 0.73-0.81), and to the composite outcome (AUC 0.72, 95% CI 0.68-0.76). Patients with RISE UP scores below 10% (121 patients) had favourable outcome (0% mortality and 5% ICU admissions). Patients with a RISE UP score above 30% (221 patients) were at high risk of adverse outcome (46.6% mortality and 19% ICU admissions).ConclusionThe RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome, and may help guiding decision-making and allocating healthcare resources.

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CT in relation to RT-PCR in diagnosing COVID-19 in the Netherlands: a prospective study

Cited by 26 publications

References 25 publications

False-Negative Results of Initial Rt-PCR Assays for Covid-19: A Systematic Review

False-Negative Results of Initial Rt-PCR Assays for Covid-19: A Systematic Review

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

Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department, a retrospective study

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