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Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study.
Borakati, Aditya; Perera, Adrian; Johnson, James; Sood, Tara.
  • Borakati A; Division of Surgery and Interventional Science, University College London, London, London, UK a.borakati@doctors.org.uk.
  • Perera A; Emergency Department, Royal Free Hospital, London, London, UK.
  • Johnson J; Emergency Department, Royal Free Hospital, London, London, UK.
  • Sood T; Emergency Department, Royal Free Hospital, London, London, UK.
BMJ Open ; 10(11): e042946, 2020 11 06.
Article in English | MEDLINE | ID: covidwho-913770
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF General Population
Subject
COVID-19
Predicate
PROCESS_OF
Object
General Population
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Oropharyngeal swab PART_OF Nose
Subject
Oropharyngeal swab
Predicate
PART_OF
Object
Nose
4. COVID-19 PROCESS_OF General Population
Subject
COVID-19
Predicate
PROCESS_OF
Object
General Population
5. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
6. Oropharyngeal swab PART_OF Nose
Subject
Oropharyngeal swab
Predicate
PART_OF
Object
Nose
ABSTRACT

OBJECTIVES:

To identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients.

DESIGN:

Retrospective analysis of electronic patient records.

SETTING:

Tertiary academic health science centre and designated centre for high consequence infectious diseases in London, UK.

PARTICIPANTS:

1198 patients who attended the emergency department with paired reverse transcriptase PCR (RT-PCR) swabs for SARS-CoV-2 and CXR between 16 March and 16 April 2020. MAIN OUTCOME

MEASURES:

Sensitivity and specificity of CXR and CT for diagnosis of COVID-19 using the British Society of Thoracic Imaging reporting templates. Reference standard was any RT-PCR positive naso-oropharyngeal swab within 30 days of attendance. ORs of CXR in association with vital signs, laboratory values and 30-day outcomes were calculated.

RESULTS:

Sensitivity and specificity of CXR for COVID-19 diagnosis were 0.56 (95% CI 0.51 to 0.60) and 0.60 (95% CI 0.54 to 0.65), respectively. For CT scans, these were 0.85 (95% CI 0.79 to 0.90) and 0.50 (95% CI 0.41 to 0.60), respectively. This gave a statistically significant mean increase in sensitivity with CT of 29% (95% CI 19% to 38%, p<0.0001) compared with CXR. Specificity was not significantly different between the two modalities.CXR findings were not statistically significantly or clinically meaningfully associated with vital signs, laboratory parameters or 30-day outcomes.

CONCLUSIONS:

CT has substantially improved diagnostic performance over CXR in COVID-19. CT should be strongly considered in the initial assessment for suspected COVID-19. This gives potential for increased sensitivity and considerably faster turnaround time, where capacity allows and balanced against excess radiation exposure risk.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Radiography, Thoracic / Tomography, X-Ray Computed / Emergency Service, Hospital / Propensity Score / SARS-CoV-2 / COVID-19 / Lung Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Limits: Female / Humans / Male / Middle aged Language: English Journal: BMJ Open Year: 2020 Document Type: Article Affiliation country: Bmjopen-2020-042946

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Radiography, Thoracic / Tomography, X-Ray Computed / Emergency Service, Hospital / Propensity Score / SARS-CoV-2 / COVID-19 / Lung Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Limits: Female / Humans / Male / Middle aged Language: English Journal: BMJ Open Year: 2020 Document Type: Article Affiliation country: Bmjopen-2020-042946