Chest CT in the emergency department for suspected COVID-19 pneumonia
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Chest CT in the emergency department for suspected COVID-19 pneumonia Anna Palmisano1,2 · Giulia Maria Scotti3 · Davide Ippolito4,5 · Marco J. Morelli3 · Davide Vignale1,2 · Davide Gandola4,5 · Sandro Sironi5,6 · Francesco De Cobelli1,2 · Luca Ferrante7 · Marzia Spessot7 · Giovanni Tonon3 · Carlo Tacchetti1,2 · Antonio Esposito1,2 Received: 4 June 2020 / Accepted: 20 October 2020 © Italian Society of Medical Radiology 2020
Abstract Purpose In overwhelmed emergency departments (EDs) facing COVID-19 outbreak, a swift diagnosis is imperative. CT role was widely debated for its limited specificity. Here we report the diagnostic role of CT in two EDs in Lombardy, epicenter of Italian outbreak. Material and methods Admitting chest CT from 142 consecutive patients with suspected COVID-19 were retrospectively analyzed. CT scans were classified in “highly likely,” “likely,” and “unlikely” COVID-19 pneumonia according to the presence of typical, indeterminate, and atypical findings, or “negative” in the absence of findings, or “alternative diagnosis” when a different diagnosis was found. Nasopharyngeal swab results, turnaround time, and time to positive results were collected. CT diagnostic performances were assessed considering RT-PCR as reference standard. Results Most of cases (96/142, 68%) were classified as “highly likely” COVID-19 pneumonia. Ten (7%) and seven (5%) patients were classified as “likely” and “unlikely” COVID-19 pneumonia, respectively. In 21 (15%) patients a differential diagnosis was provided, including typical pneumonia, pulmonary edema, neoplasia, and pulmonary embolism. CT was negative in 8/142 (6%) patients. Mean turnaround time for the first COVID-19 RT-PCR was 30 ± 13 h. CT diagnostic accuracy in respect of the first test swab was 79% and increased to 91.5% after repeated swabs and/or BAL, for 18 false-negative first swab. CT performance was good with 76% specificity, 99% sensitivity, 90% positive predictive value and 97% negative predictive value. Conclusion Chest CT was useful to streamline patients’ triage while waiting for RT-PCR in the ED, supporting the clinical suspicion of COVID-19 or providing alternative diagnosis. Keywords COVID-19 · Diagnosis · Computed tomography · Triage · Emergency * Antonio Esposito [email protected] 1
Experimental Imaging Centre, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
2
School of Medicine, Vita-Salute San Raffaele University, via Olgettina 58, 20132 Milan, Italy
3
Center for Omics Sciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
4
Diagnostic Radiology, San Gerardo Hospital, School of Medicine and Surgery, Monza, Italy
5
University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy
6
Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
7
Emergency Medicine, Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
Chest CT in the emergency department for suspected COVID‑19 pneumonia SARS-CoV-2 spread worldwide causing cor
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