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01-03-2021 | COVID-19 | Short Communication

Chest CT in the emergency department for suspected COVID-19 pneumonia

Authors: Anna Palmisano, MD, Giulia Maria Scotti, MSc, Davide Ippolito, MD, Marco J. Morelli, PhD, Davide Vignale, MD, Davide Gandola, MD, Sandro Sironi, MD, Francesco De Cobelli, MD, Luca Ferrante, Marzia Spessot, Giovanni Tonon, MD, PhD, Carlo Tacchetti, MD, Antonio Esposito, MD

Published in: La radiologia medica | Issue 3/2021

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.

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Title: Chest CT in the emergency department for suspected COVID-19 pneumonia
Authors: Anna Palmisano, MD
Giulia Maria Scotti, MSc
Davide Ippolito, MD
Marco J. Morelli, PhD
Davide Vignale, MD
Davide Gandola, MD
Sandro Sironi, MD
Francesco De Cobelli, MD
Luca Ferrante
Marzia Spessot
Giovanni Tonon, MD, PhD
Carlo Tacchetti, MD
Antonio Esposito, MD
Publication date: 01-03-2021
Publisher: Springer Milan
Keywords: COVID-19
Pneumonia
Triage
Published in: La radiologia medica / Issue 3/2021
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-020-01302-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Chest CT in the emergency department for suspected COVID-19 pneumonia

Abstract

Purpose

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Material and methods

Results

Conclusion

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