Clinical and radiological characteristics in patients with SARS-CoV-2-associated pneumonia. A descriptive study in a secondary care center.

INTRODUCTION: Real-time reverse-transcription polymerase chain reaction (RT-PCR) is the gold standard for establishing the diagnosis of coronavirus disease 2019 (COVID-19). Chest computed tomography (CCT), as a diagnostic complement, classifies tomographic findings according to the COVID-19 Reporting and Data System (CO-RADS). OBJECTIVE: To determine CCT sensitivity and specificity for COVID-19 diagnosis. METHODS: We reviewed RT-PCR results, as well as their respective CCTs. All CCTs were classified according to CO-RADS. CCT sensitivity and specificity were evaluated using the RT-PCR result that was closest to that of CCT as reference. RESULTS: We included 412 patients, out of whom 277 were males (46-70 years) and 130 were females (45-71 years); with 181 negative and 231 positive tests, a sensitivity of 92.15% and specificity of 79.32% were obtained. Mortality increased after six hospitalization days, in males and in CO-RADS 4, 5 and 6 in comparison with CO-RADS 1, 2 and 3. CONCLUSIONS: Early diagnosis plays a decisive role in the prognosis of SARS-CoV-2-associated pneumonia. Although RT-PCR is current gold standard, false negatives are common; for this reason, CCT helps to confirm suspected cases, even at early stages. This imaging technique is an accessible and fundamental study for classification, diagnosis and prognosis.

INTRODUCCIÓN: La reacción en cadena de la polimerasa con transcripción inversa en tiempo real (RT-PCR) es el estándar de oro para establecer el diagnóstico de enfermedad por coronavirus 2019 (COVID-19). La tomografía computarizada de tórax (TCT), como complemento diagnóstico, clasifica los hallazgos tomográficos de acuerdo con el sistema CO-RADS (COVID-19 Reporting and Data System). OBJETIVO: Determinar la sensibilidad y especificidad de la TCT para el diagnóstico de COVID-19. MÉTODOS: Consultamos los resultados de RT-PCR, así como sus respectivas TCT. Todas las TCT se clasificaron de según CO-RADS. Se evaluó sensibilidad y especificidad de la TCT utilizando el resultado de RT-PCR más cercano de TCT como referencia. RESULTADOS: Incluimos 412 pacientes, incluyendo 277 hombres (46-70 años) y 130 mujeres (45-71 años), con 181 pruebas negativas y 231 positivas; obteniendo sensibilidad del 92.15% y especificidad del 79.32%. La mortalidad aumentó después de seis días de hospitalización, en el sexo masculino y en CO-RADS 4, 5 y 6 en comparación con CO-RADS 1, 2 y 3. CONCLUSIONES: El diagnóstico temprano es decisivo en el pronóstico de la neumonía SARS CoV 2. Aunque la RT-PCR es el estándar de oro actual, los falsos negativos son frecuentes, por lo que la TCT ayuda a confirmar los casos sospechosos, incluso en etapas tempranas. Este estudio de imagen es un estudio accesible y fundamental para la clasificación, diagnóstico y pronóstico.

Reliability of Bystander Recognition of Clinical Features in Pre-Hospital Classification of Acute Cerebrovascular Syndromes: Preliminary Findings.

BACKGROUND: The recognition of stroke symptoms by patients or bystanders directly affects the outcomes of patients with acute cerebrovascular disease. OBJECTIVE: The objective of the study was to assess the predictive value of the medical his- tory and clinical features recognized by the patients' bystanders to classify neurovascular syndromes in pre-hospital settings. METHODS: We included 150 stroke patients of two Mexican referral centers: 50 with acute ischemic stroke (AIS), 50 with intracerebral hemorrhage (ICH), and 50 with subarachnoid hemorrhage (SAH). The performance of clinical prediction rules (CPR) to identify the stroke types was evaluated with features recognized by the patients' bystanders before hospital arrival. The impact of CPRs on early arrival and in-hospital mortality was also analyzed. RESULTS: Overall, 72% of the patients had previous medical evaluations in other centers before final referral to our hospitals, and therefore, only 45% had a final onset- to-door time <6 h, even when the first medical assessment had occurred in ≤1 h in 75% of cases. Clinical features noticed by the patients' bystanders had low positive predictive values (PPV) for any stroke type. The CPR "language or speech disor- der + focal motor deficit" had 93% sensitivity and a negative predictive value (NPV) of 84% to distinguish AIS. In SAH, head- ache alone showed a sensitivity of 84% and NPV of 97%. No CPR had an adequate performance on ICH. CPRs were not as- sociated with final onset-to-door time. Altered consciousness, age ≥65 years, indirect arrival with stops before final referral, and atrial fibrillation increased in-hospital mortality. CONCLUSION: Clinical features referred by the witness of a neurovascular emergency have limited PPV, but adequate NPV in ruling-out AIS and SAH among stroke types. The use of CPRs had no impact on onset-to-door time or in-hospital mortality when the final arrival to a third-level center occurs with previous medical refer- rals.