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Chest CT for rapid triage of patients in multiple emergency departments during COVID-19 epidemic: experience report from a large French university hospital.
Ducray, Victoria; Vlachomitrou, Anna Sesilia; Bouscambert-Duchamp, Maude; Si-Mohamed, Salim; Gouttard, Sylvain; Mansuy, Adeline; Wickert, Florian; Sigal, Alain; Gaymard, Alexandre; Talbot, François; Michel, Catherine; Perpoint, Thomas; Pialat, Jean-Baptiste; Rouviere, Olivier; Milot, Laurent; Cotton, François; Douek, Philippe; Rabilloud, Muriel; Boussel, Loic.
  • Ducray V; Department of Radiology, Hospices Civils de Lyon, Lyon, France.
  • Vlachomitrou AS; PHILIPS France, 33, rue de Verdun, CS 60 055, 92156, Suresnes Cedex, France.
  • Bouscambert-Duchamp M; Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, F-69317, Lyon, France.
  • Si-Mohamed S; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372, Lyon, France.
  • Gouttard S; Department of Radiology, Hospices Civils de Lyon, Lyon, France. salim.si-mohamed@chu-lyon.fr.
  • Mansuy A; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France. salim.si-mohamed@chu-lyon.fr.
  • Wickert F; Department of cardiothoracic and vascular imaging, CHU cardiologique Louis Pradel, 59 Boulevard Pinel, 69500, Bron, France. salim.si-mohamed@chu-lyon.fr.
  • Sigal A; Department of Radiology, Hospices Civils de Lyon, Lyon, France.
  • Gaymard A; Department of Radiology, Hospices Civils de Lyon, Lyon, France.
  • Talbot F; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France.
  • Michel C; Department of Emergency, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
  • Perpoint T; Laboratoire de Virologie, Institut des Agents Infectieux de Lyon, Centre National de Référence des virus respiratoires France Sud, Centre de Biologie et de Pathologie Nord, Hospices Civils de Lyon, F-69317, Lyon, France.
  • Pialat JB; Université de Lyon, Virpath, CIRI, INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon 1, F-69372, Lyon, France.
  • Rouviere O; Department of Information Technology, Hospices Civils de Lyon, Lyon, France.
  • Milot L; Department of Information Technology, Hospices Civils de Lyon, Lyon, France.
  • Cotton F; Service de Maladies Infectieuses et Tropicales, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
  • Douek P; Department of Radiology, Hospices Civils de Lyon, Lyon, France.
  • Rabilloud M; Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69621, Lyon, France.
  • Boussel L; Department of Radiology, Hospices Civils de Lyon, Lyon, France.
Eur Radiol ; 31(2): 795-803, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-722374
ABSTRACT

OBJECTIVES:

To assess the diagnostic performances of chest CT for triage of patients in multiple emergency departments during COVID-19 epidemic, in comparison with reverse transcription polymerase chain reaction (RT-PCR) test.

METHOD:

From March 3 to April 4, 2020, 694 consecutive patients from three emergency departments of a large university hospital, for which a hospitalization was planned whatever the reasons, i.e., COVID- or non-COVID-related, underwent a chest CT and one or several RT-PCR tests. Chest CTs were rated as "Surely COVID+," "Possible COVID+," or "COVID-" by experienced radiologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the final RT-PCR test as standard of reference. The delays for CT reports and RT-PCR results were recorded and compared.

RESULTS:

Among the 694 patients, 287 were positive on the final RT-PCR exam. Concerning the 694 chest CT, 308 were rated as "Surely COVID+", 34 as "Possible COVID+," and 352 as "COVID-." When considering only the "Surely COVID+" CT as positive, accuracy, sensitivity, specificity, PPV, and NPV reached 88.9%, 90.2%, 88%, 84.1%, and 92.7%, respectively, with respect to final RT-PCR test. The mean delay for CT reports was three times shorter than for RT-PCR results (187 ± 148 min versus 573 ± 327 min, p < 0.0001).

CONCLUSION:

During COVID-19 epidemic phase, chest CT is a rapid and most probably an adequately reliable tool to refer patients requiring hospitalization to the COVID+ or COVID- hospital units, when response times for virological tests are too long. KEY POINTS • In a large university hospital in Lyon, France, the accuracy, sensitivity, specificity, PPV, and NPV of chest CT for COVID-19 reached 88.9%, 90.2%, 88%, 84.1%, and 92.7%, respectively, using RT-PCR as standard of reference. • The mean delay for CT reports was three times shorter than for RT-PCR results (187 ± 148 min versus 573 ± 327 min, p < 0.0001). • Due to high accuracy of chest CT for COVID-19 and shorter time for CT reports than RT-PCR results, chest CT can be used to orient patients suspected to be positive towards the COVID+ unit to decrease congestion in the emergency departments.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Triage / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male Country/Region as subject: Europa Language: English Journal: Eur Radiol Journal subject: Radiology Year: 2021 Document Type: Article Affiliation country: S00330-020-07154-4

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Triage / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male Country/Region as subject: Europa Language: English Journal: Eur Radiol Journal subject: Radiology Year: 2021 Document Type: Article Affiliation country: S00330-020-07154-4