Diagnostic performance of chest radiography in high COVID-19 prevalence setting: experience from a European reference hospital.

ABSTRACT

PURPOSE: The study's aim is to analyse the diagnostic performance of chest radiography (CXR) in patients with suspected coronavirus disease 19 (COVID-19). METHODS: We retrospectively considered 826 consecutive patients with suspected COVID-19 presenting to our emergency department (ED) from February 21 to March 31, 2020, in a high disease prevalence setting. We enrolled patients who underwent CXR and rhino-oropharyngeal swab for real-time reverse transcription-polymerase chain reaction (rRT-PCR). CXRs were evaluated by an expert radiologist; a second independent analysis was performed by two residents in consensus. All readers, blinded to rRT-PCR results, classified CXRs positive/negative depending on presence/absence of typical findings of COVID-19, using rRT-PCR as reference standard. RESULTS: We finally analysed 680 patients (median age 58); 547 (80%) tested positive for COVID-19. The diagnostic performance of CXR, interpreted by the expert reader, was as follows sensitivity (79.0%; 95% CI 75.3-82.3), specificity (81.2%; 95% CI 73.5-87.5), PPV (94.5%;95% CI 92.0-96.4), NPV (48.4%; 95% CI 41.7-55.2), and accuracy (79.3%; 95% CI 76.0-82.2). For the residents sensitivity (75.1%; 95% CI 71.2-78.7), specificity (57.9%; 95% CI 49.9-66.4), PPV (88.0%; 95% CI 84.7-90.8), NPV (36.2%; 95% CI 29.7-43.0), and accuracy (71.6%; 95% CI 68.1-75.0). We found a significant difference between the reporting sensitivity (p = 0.013) and specificity (p < 0.0001) of expert radiologist vs residents. CXR sensitivity was higher in patients with symptom onset > 5 days before ED presentation compared to ≤ 5 days (84.4% vs 70.7%). CONCLUSIONS: CXR showed a sensitivity of 79% and a specificity of 81% in diagnosing viral pneumonia in symptomatic patients with clinical suspicion of COVID-19. Further studies in lower prevalence settings are needed.