Correlation between chest CT and RT-PCR testing in India’s second COVID-19 wave: a retrospective cohort study

医学 回顾性队列研究 肺炎 2019年冠状病毒病(COVID-19) 队列 放射科 试验预测值 计算机断层摄影术 内科学 疾病 传染病(医学专业)
作者
Vishisht Mehta,Divya Jyoti,Rishi Tuhin Guria,Chandra Bhushan Sharma
出处
期刊:BMJ evidence-based medicine [BMJ]
卷期号:27 (5): 305-312 被引量:3
标识
DOI:10.1136/bmjebm-2021-111801
摘要

A novel coronavirus, later designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was found to be responsible for a cluster of pneumonia cases originating in Wuhan City, Hubei province, China and the clinical disease caused by it came to be known as COVID-19. Tests in use for diagnosing COVID-19 infection in India included molecular based tests - RT-PCR, TrueNat and CBNAATAs. As COVID-19 primarily targets the lungs, Chest Computed Tomography (CT) would play a crucial role in the diagnosis, evaluation, and management of the disease. Study was done to assess the diagnostic accuracy of chest computed tomography (CT) in clinically suspected COVID - 19 patients using RT-PCR as the reference standard and establish the correlation between CT Severity Score (CTSS) and RT-PCR results. Material: A single centre tertiary care hospital based retrospective cohort suty was performed on 112 clinically suspected COVID - 19 patients between 1st April 2021 and 31st May 2021. Chest CT and RT-PCR tests were performed for all patients at a time interval of no longer than 7 days between the two tests. Patients with prior chronic respiratory illnesses were excluded. The diagnostic performance of Chest CT was evaluated using RT-PCR as the reference standard. The CTSS was calculated for all patients with positive Chest CT findings, and it was correlated with results of the RT-PCR assay. The primary outcome measures were determination of the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of Chest CT using RT-PCR as the standard of reference. The correlation between CTSS and RT-PCR was the secondary outcome. Observation: 85/112 (76%) patients tested positive on the RT-PCR whereas 91/112 (81%) had chest CT findings typical of SARS-CoV2 infection. Chest CT had a sensitivity of 90.6% [95% CI, 82.3% - 95.8%], a specificity of 48.1% [95% CI 28.7% - 68.0%], a PPV of 84.6% [95% CI, 79.2% - 88.8%], a NPV of 61.9% [95% CI, 43.0% - 77.8%] and an accuracy of 80.4% [95% CI, 71.8% - 87.3%]. There was a significant correlation between the CTSS and RT-PCR positivity (p value = 0.003) Conclusion: Chest CT has a good sensitivity in detecting COVID-19 pneumonia and is useful for moderate to-severe COVID-19 cases in resource limited settings, where RT-PCR testing is cumbersome due to lack of personnel, time, and diagnostic kits.
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