Macklin effect on baseline chest CT scan accurately predicts barotrauma in COVID-19 patients.
Respir Med
; 197: 106853, 2022 06.
Article
in English
| MEDLINE | ID: covidwho-1796148
ABSTRACT
PURPOSE:
To validate the role of Macklin effect on chest CT imaging in predicting subsequent occurrence of pneumomediastinum/pneumothorax (PMD/PNX) in COVID-19 patients. MATERIALS ANDMETHODS:
This is an observational, case-control study. Consecutive COVID-19 patients who underwent chest CT scan at hospital admission during the study time period (October 1st, 2020-April 31st, 2021) were identified. Macklin effect accuracy for prediction of spontaneous barotrauma was measured in terms of sensitivity, specificity, positive (PPV) and negative predictive values (NPV).RESULTS:
Overall, 981 COVID-19 patients underwent chest CT scan at hospital arrival during the study time period; 698 patients had radiological signs of interstitial pneumonia and were considered for further evaluation. Among these, Macklin effect was found in 33 (4.7%), including all 32 patients who suffered from barotrauma lately during hospital stay (true positive rate 96.9%); only 1/33 with Macklin effect did not develop barotrauma (false positive rate 3.1%). No barotrauma event was recorded in patients without Macklin effect on baseline chest CT scan. Macklin effect yielded a sensitivity of 100% (95% CI 89.1-100), a specificity of 99.85% (95% CI 99.2-100), a PPV of 96.7% (95% CI 80.8-99.5), a NPV of 100% and an accuracy of 99.8% (95% CI 99.2-100) in predicting PMD/PNX, with a mean advance of 3.2 ± 2.5 days. Moreover, all Macklin-positive patients developed ARDS requiring ICU admission and, in 90.1% of cases, invasive mechanical ventilation.CONCLUSIONS:
Macklin effect has high accuracy in predicting PMD/PNX in COVID-19 patients; it is also an excellent predictor of disease severity.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumothorax
/
Barotrauma
/
COVID-19
/
Mediastinal Emphysema
Type of study:
Diagnostic study
/
Experimental Studies
/
Observational study
/
Prognostic study
Topics:
Long Covid
Limits:
Humans
Language:
English
Journal:
Respir Med
Year:
2022
Document Type:
Article
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