The use of ultrasound in establishing COVID-19 infection as part of a trauma evaluation.

PURPOSE: The use of lung ultrasound for diagnosis of COVID-19 has emerged during the pandemic as a beneficial diagnostic modality due to its rapid availability, bedside use, and lack of radiation. This study aimed to determine if routine ultrasound (US) imaging of the lungs of trauma patients with COVID-19 infections who undergo extended focused assessment with sonography for trauma (EFAST) correlates with computed tomography (CT) imaging and X-ray findings, as previously reported in other populations. METHODS: This was a prospective, observational feasibility study performed at two level 1 trauma centers. US, CT, and X-ray imaging were retrospectively reviewed by a surgical trainee and a board-certified radiologist to determine any correlation of imaging findings in patients with active COVID-19 infection. RESULTS: There were 53 patients with lung US images from EFAST available for evaluation and COVID-19 testing. The overall COVID-19 positivity rate was 7.5%. COVID-19 infection was accurately identified by one patient on US by the trainee, but there was a 15.1% false-positive rate for infection based on the radiologist examination. CONCLUSIONS: Evaluation of the lung during EFAST cannot be used in the trauma setting to identify patients with active COVID-19 infection or to stratify patients as high or low risk of infection. This is likely due to differences in lung imaging technique and the presence of concomitant thoracic injury.

COVID-19: using chest CT of major trauma patients to monitor and evaluate the second wave in London and the development of routine monitoring in practice.

AIM: To follow-up previous work evaluating incidental findings of COVID-19 signs on computed tomography (CT) images of major trauma patients to include the second wave prior to any major effects from vaccines. MATERIALS AND METHODS: The study population included all patients admitted following major trauma between 1 January 2020 and 28 February 2021 with CT including the lungs (n=1776). Major trauma patients admitted pre-COVID-19 from alternate months from January 2019 to November 2019 comprised a control group (n=837). The assessing radiologists were blinded to the time period and used double reading in consensus to determine if the patient had signs of COVID-19. Lung appearances were classified as no evidence of COVID-19, minor signs, or major signs. RESULTS: The method successfully tracked the second wave of the COVID-19 pandemic in London. The estimated population affected by the disease based on those with major signs was similar to estimates of the proportion of the population in London with antibodies (around 30% by end February 2021) and the total of major and minor signs produced a much higher figure of 68%, which may include all those with both antibody and just T-cell responses. CONCLUSIONS: Incidental findings on CT from major trauma patients may provide a novel and sensitive way of tracking the virus. It is recommended that all major trauma units include a simple question on signs of COVID-19 to provide an early warning system for further waves.

Systematic review and meta-analysis of whole-body computed tomography compared to conventional radiological procedures of trauma patients.

PURPOSE: The superior diagnostic accuracy of CT makes it an attractive tool for initial trauma imaging. This meta-analysis aimed to assess the evidence regarding the value of whole-body CT (WBCT) as part of the primary survey, in comparison to conventional radiological procedures. METHODS: A comprehensive systematic search of the literature was conducted using keywords applied in Scopus, Cochrane and PubMed databases. Articles were eligible if they contained original data comparing the use of WBCT in the primary survey, with conventional radiological procedures. Outcomes included overall and 24 -h mortality, emergency department (ED) time, intensive care unit (ICU) and hospital length of stay (LOS), and multiple organ dysfunction syndrome/failure (MODS/MOF) incidence. Radiation dose, mechanical ventilation duration and cost were evaluated qualitatively. Analysis was performed with Covidence, MedCalc Version 19.1.3. and Meta-Essentials. RESULTS: Fourteen studies were included. Statistical pooling demonstrated comparable rates between conventional procedures and WBCT (OR = 0.854, CI = 0.715-1.021, p = 0.083) in 63,529 patients across 11 studies. A significant finding favouring WBCT was discovered for ED time (SMD = -0.709, CI -1.198 to -0.220, p = 0.004). Patients experienced similar 24 -h mortality rates (p = 0.450), MODS/MOF incidence (p = 0.274), and hospital (p = 0.541) and ICU LOS (p = 0.457). WBCT is associated with increased radiation dose and mechanical ventilation duration. CONCLUSION: This review demonstrates that WBCT markedly reduces time spent in ED. No significant differences in mortality rate are suggested. WBCT currently entails greater radiation dose and mechanical ventilation time. Further research is necessitated to address limitations of predominately retrospective observational data available.

COVID-19: using chest CT of major trauma patients to monitor and evaluate the effect of lockdown and the importance of household size.

AIM: To use theory and practice to show how disease progression and regression can be described pre- and post-lockdown using an attack-sustain-decline-respite (ASDR) model and investigate how pre-lockdown disease prevalence and household size impacts on the effectiveness of lockdown. MATERIALS AND METHODS: Computed tomography (CT) scans from major trauma patients (considered as a random population sample) from the radiology department of St George's University Hospitals NHS Trust, London, have been used to explore COVID-19 disease at the population level. RESULTS: At lockdown on 23 March 2020 in the catchment area of St George's University Hospitals NHS Trust, an earlier paper showed that there was a high prevalence of disease of >20%. With further follow-up and at the end of lockdown, it have been now estimated that around 57% of the population had been affected, which was similar to that predicted from a simple model based on average household size and prevalence at lockdown. With an average household size of around three persons, there was a 2-week sustain period and a 5-week decline period before the prevalence of the disease returned to background levels. CONCLUSIONS: The present results suggest that the effect of lockdown is dependent on the disease prevalence at the start of lockdown and the average household size. It may therefore be important to lockdown early in an area with a high average household size. This paper is the second in a series of papers to show how radiology measurements of major trauma patients can be used to help monitor the spread of the COVID-19 pandemic.

COVID-19: could CT provide the best population level biomarker? Incidental COVID-19 in major trauma patients suggests higher than predicted rates of infection in London.

AIM: To evaluate incidental findings in major trauma patients, and to explore whether computed tomography (CT) could be used to assess prevalence and estimate disease spread in the general population. MATERIALS AND METHODS: The study population included all patients admitted following major trauma between 1 January 2020 and 30 April 2020 with CT including the lungs (n=523). Major trauma patients admitted pre-COVID-19 from 1-31 January and 1-31 March 2019 comprised a control group (n=252). The assessing radiologists, blinded to the time period, used double reading with consensus to determine if the patient had CT signs of COVID-19. Lung appearances were classified as no evidence of COVID-19; minor signs; or major signs. The proportion of patients with incidental COVID-19 changes was recorded over the study period, and the percentage of the population who had been affected by COVID-19 by the end of April 2020 estimated. RESULTS: CT appearances consistent with COVID-19 began to exceed a background pre-COVID rate in the second week of February and did not decline until 2 weeks after lockdown. By the end of April 2020, approximately 45% of the population had been infected. CONCLUSIONS: CT of major trauma patients can be used to monitor the spread of COVID-19. This novel technique could be used retrospectively or prospectively anywhere where trauma scans are available, to monitor the disease in the local population.