COVID-19 pneumonia in the emergency department: correlation of initial chest CT findings with short-term outcome
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ORIGINAL ARTICLE
COVID-19 pneumonia in the emergency department: correlation of initial chest CT findings with short-term outcome Camila Silva Barbosa 1 & Guilherme Wilson Otaviano Garcia Chaves 1 & Camila Vilela de Oliveira 1 & Guilherme Hipolito Bachion 1 & Chang Kai Chi 1 & Giovanni Guido Cerri 1,2 & Thais Carneiro Lima 1 & Hye Ju Lee 1 Received: 17 July 2020 / Accepted: 9 October 2020 # American Society of Emergency Radiology 2020
Abstract Purpose Evaluate chest computed tomography (CT) findings of laboratory-confirmed Coronavirus Disease 2019 (COVID-19) cases and correlate it with clinical and laboratorial signs of severe disease and short-term outcome. Methods Chest CTs of 61 consecutive cases of COVID-19 disease that attended in our emergency department (ED) were reviewed. Three groups of patients classified according to the short-term follow-up were compared: (1) early-discharged from ED, (2) hospitalized on regular wards, and (3) admitted to intensive care unit (ICU). CT findings were also correlated with clinical and laboratorial features associated with severe disease. Results Median age was 52 years (IQR 39–63) with male predominance (60.7%). Most of the patients that did not require hospitalization had parenchymal involvement of less than 25% on CT (84.6%). Among hospitalized patients, interlobular septal thickening and extensive lung disease (> 50% of parenchyma) were significantly more frequent in ICU-admitted patients (P = 0.018 and P = 0.043, respectively). Interlobular septal thickening also correlated with longer ICU stay (P = 0.018). Low oxygen saturation (SpO2 ≤ 93%) was associated with septal thickening (P = 0.004), diffuse distribution (P = 0.016), and pleural effusion (P = 0.037) on CT. All patients with > 50% of parenchymal involvement showed SpO2 ≤ 93%. Elevated C-reactive protein (CRP) levels (> 5.0 mg/dL) correlated with consolidation (P = 0.002), septal thickening (P = 0.018), diffuse distribution (P = 0.020), and more extensive parenchymal involvement (P = 0.017). Conclusion Interlobular septal thickening on CT was associated with ICU admission and longer stay on ICU. Diffuse distribution, septal thickening, and more extensive lung involvement correlated with lower SpO2 and higher CRP levels. Patients that needed hospitalization and ICU admission presented more extensive lung disease on CT. Keywords Coronavirus . COVID-19 . Tomography . Radiology . Patient outcome assessment . Emergency medicine
Introduction In December 2019, a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak began in Wuhan City, Hubei, China. The disease caused by SARS-CoV-2 was named Coronavirus Disease 2019 (COVID-19). There was a rapid increase in the number of cases and due to the fast geographic spread, and the outbreak was
* Camila Silva Barbosa [email protected] 1
Radiology Department, Sírio Libanês Hospital, Sao Paulo, Brazil
2
University of São Paulo (USP), Sao Paulo, Brazil
declared a Public Health Emergency of International Concern on January 30, 2020. On March 11, 2020
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