The accuracy of teleradiologists in diagnosing COVID-19 based on a French multicentric emergency cohort

Abstract

Objectives: To evaluate the accuracy of diagnoses of COVID-19 based on chest CT as well as inter-observer agreement between teleradiologists during on-call duty and senior radiologists in suspected COVID-19 patients. Materials and Methods: From 03/13/2020 to 04/14/2020, consecutive suspected COVID-19 adult patients who underwent both an RT-PCR test and chest CT from 15 hospitals were included in this prospective study. Chest CTs were immediately interpreted by the on-call teleradiologist and were systematically blind reviewed by a senior radiologist. Readings were categorised using a five-point scale: (1) normal; (2) non-infectious findings; (3) infectious findings but not consistent with COVID-19 infection; (4) consistent with COVID-19 infection; and (5) typical appearance of COVID-19 infection. The diagnostic accuracy of chest CT and inter-observer agreement using the Kappa coefficient were evaluated over the study period.Results: In total, 513 patients were enrolled, of whom 244/513 (47.6%) tested positive for RT-PCR. First readings were scored 4 or 5 in 225/244 (92%) RT-PCR+ patients, and between 1 and 3 in 201/269 (74.7%) RT-PCR- patients. The data were highly consistent (weighted Kappa=0.87) and correlated with RT-PCR (p<0.001, AUC1st-reading=0.89, AUC2nd-reading=0.93). The negative predictive value for scores of 4 or 5 was 0.91–0.92, and the PPV for a score of 5 was 0.89–0.96 at the first and second readings, respectively. Diagnostic accuracy was consistent over the study period, irrespective of a variable prevalence rate.Conclusion: Chest CT demonstrated high diagnostic accuracy with strong inter-observer agreement between on-call teleradiologists with varying degrees of experience and senior radiologists over the study period.

The role of chest imaging in the diagnosis, management, and monitoring of coronavirus disease 2019 (COVID-19)

“…The PPV and NPV for CO-RADS 5 were reported to be 86% and 75% at the incidence of 50%, respectively [77]. Similar trends were observed in the subsequent reports from other countries including Belgium [70], France [75], Germany [78], Italy [73,74], and Japan [49,71] and other institutions from the Netherlands [68,69,72,76,77].…”

“…Excluding categories of negative CT findings, the proportion of COVID-19 positivity for each category was roughly parallel to the level of suspicion of the category in each classification system [49]. In some studies, however, a reversed incidence was observed in the lowest two categories [49,61,63,66,[68][69][70]75]. For example, the proportion of CO-RADS 1 (negative CT findings) was higher than CO-RADS 2 (suspected pneumonia caused by other pathogen), and a similar trend was seen in RSNA "negative for pneumonia" and RSNA "atypical appearance", COVID-RADS 1 and 2, or BSTI "NON-COVID" and "INDETERMINATE" [49,[68][69][70]75].…”

“…In some studies, however, a reversed incidence was observed in the lowest two categories [49,61,63,66,[68][69][70]75]. For example, the proportion of CO-RADS 1 (negative CT findings) was higher than CO-RADS 2 (suspected pneumonia caused by other pathogen), and a similar trend was seen in RSNA "negative for pneumonia" and RSNA "atypical appearance", COVID-RADS 1 and 2, or BSTI "NON-COVID" and "INDETERMINATE" [49,[68][69][70]75]. This may be easily understood because the incidence of CT negative patients in COVID-19 and pneumonia of other etiology may be changeable depending on the inclusion criteria among communityacquired infection populations.…”

“…Diagnostic performance of CO-RADS was evaluated in both symptomatic and asymptomatic patients with reference to RT-PCR as summarized in Table 3 [49,59,[68][69][70][71][72][73][74][75][76][77][78]. A retrospective single-center cohort study from the Netherlands that included 1070 symptomatic patients with suspected COVID-19 from March 22 to April 7, 2020, showed that the sensitivity and specificity of CO-RADS 5 were 71% and 88%, respectively.…”

Telehealth-Based Services During the COVID-19 Pandemic: A Systematic Review of Features and Challenges

“…Regarding diagnosis purpose, in some studies, teleconsultation services were used by physicians to do diagnosis procedures. In some other studies, an attempt was made to perform the diagnosis process with the patients' participation accurately (7,42,60,62).…”