Borakati, A;
Perera, A;
Johnson, J;
Sood, T;
(2020)
Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study.
BMJ Open
, 10
(11)
10.1136/bmjopen-2020-042946.
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Abstract
Objectives: To identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients. Design: Retrospective analysis of electronic patient records. Setting Tertiary: academic health science centre and designated centre for high consequence infectious diseases in London, UK. Participants 1198 patients who attended the emergency department with paired reverse transcriptase PCR (RT-PCR) swabs for SARS-CoV-2 and CXR between 16 March and 16 April 2020. Main outcome measures: Sensitivity and specificity of CXR and CT for diagnosis of COVID-19 using the British Society of Thoracic Imaging reporting templates. Reference standard was any RT-PCR positive naso-oropharyngeal swab within 30 days of attendance. ORs of CXR in association with vital signs, laboratory values and 30-day outcomes were calculated. Results: Sensitivity and specificity of CXR for COVID-19 diagnosis were 0.56 (95% CI 0.51 to 0.60) and 0.60 (95% CI 0.54 to 0.65), respectively. For CT scans, these were 0.85 (95% CI 0.79 to 0.90) and 0.50 (95% CI 0.41 to 0.60), respectively. This gave a statistically significant mean increase in sensitivity with CT of 29% (95% CI 19% to 38%, p<0.0001) compared with CXR. Specificity was not significantly different between the two modalities. CXR findings: were not statistically significantly or clinically meaningfully associated with vital signs, laboratory parameters or 30-day outcomes. Conclusions: Computed tomography has substantially improved diagnostic performance over CXR in COVID-19. CT should be considered in the initial assessment for suspected COVID-19 instead of CXR if capacity allows and balanced against radiation exposure risk.
| Type: | Article |
|---|---|
| Title: | Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1136/bmjopen-2020-042946 |
| Language: | English |
| Additional information: | http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
| Keywords: | COVID-19, Chest imaging, accident &, emergency medicine, general medicine (see Internal Medicine), diagnostic radiology, CORONAVIRUS DISEASE 2019 |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10124249 |
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