ABSTRACT
IntroductionCurrently the main diagnostic modality for COVID-19 (Coronavirus disease-2019) is reverse transcriptase polymerase chain reaction (RT-PCR) via nasopharyngeal swab which has high false negative rates. We evaluated the performance of high-resolution computed tomography (HRCT) imaging in the diagnosis of suspected COVID-19 infection compared to RT-PCR nasopharyngeal swab alone in patients hospitalized for suspected COVID-19 infection. MethodsThis was a retrospective analysis of 324 consecutive patients admitted to Temple University Hospital. All hospitalized patients who had RT-PCR testing and HRCT were included in the study. HRCTs were classified as Category 1, 2 or 3. Patients were then divided into four groups based on HRCT category and RT-PCR swab results for analysis. ResultsThe average age of patients was 59.4 ({+/-}15.2) years and 123 (38.9%) were female. Predominant ethnicity was African American 148 (46.11%). 161 patients tested positive by RT-PCR, while 41 tested positive by HRCT. 167 (52.02%) had category 1 scan, 63 (19.63%) had category 2 scan and 91 (28.35%) had category 3 HRCT scans. There was substantial agreement between our radiologists for HRCT classification ({kappa} = 0.64). Sensitivity and specificity of HRCT classification system was 77.6 and 73.7 respectively. Ferritin, LDH, AST and ALT were higher in Group 1 and D-dimers levels was higher in Group 3; differences however were not statistically significant. ConclusionDue to its high infectivity and asymptomatic transmission, until a highly sensitive and specific COVID-19 test is developed, HRCT should be incorporated into the assessment of patients who are hospitalized with suspected COVID-19. Key PointsO_ST_ABSKey QuestionC_ST_ABSCan High Resolution CT chest (HRCT) improve diagnostic accuracy of current Nasopharyngeal swab in suspected COVID-19 patients? Bottom LineIn this retrospective analysis, our novel HRCT classification identified 20% of all COVID-19 patients who had negative nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR) tests but had HRCT findings consistent with COVID-19 pneumonia. These patients were ruled out for other infections and laboratory markers were similar to other RT-PCR positive patients Why Read onOur new HRCT classification when combined with RT-PCR can improve diagnostic accuracy while promptly improving triaging in COVID-19 patients.
ABSTRACT
This editorial is in response to Bar-Sela, Bentur, Schultz and Corn's article entitled "Spiritual care in hospitals and other healthcare settings in Israel--a profession in the making", published in Harefuah in May 2014. The integration of spiritual support into hospitals marks an interesting trend in light of the current emphases in the Israeli medical system on technological advancement, financial feasibility and quantifiable quality measures. This step is evidence of the importance still attached by policy and decisionmakers to those human aspects of illness and disease, which are difficult to define and measure. "Spiritual Support" is an ancient profession based on the principle, whereby support of the spirit is considered a basic human right, in recognition of the spirit as a source of strength during times of crisis and distress. This service was introduced into the Chaim Sheba Medical Center six years ago for patients with untreatable illnesses, and through identification of commonality between their coping features and those of rehabilitation patients. It was later expanded into the orthopedic and neurological rehabilitation departments. The service is provided on an individual level for the patients and in a group formal for their caregivers. Spiritual support as an integral part of the multi-disciplinary care further ratifies the holistic approach in medical practice, as an everlasting value transcending periodical trends. The conclusion drawn is that technological advancement, the scientific approach, physical-medical treatment, emotional therapy and spiritual support can and should exist side by side to improve the welfare and coping abilities of patients dealing with adverse medical conditions.
