Department of Radiology, Duke University School of Medicine, Durham, NC.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Chest. 2020 Jul;158(1):106-116. doi: 10.1016/j.chest.2020.04.003. Epub 2020 Apr 7.
With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.
在 2020 年前 3 个月，全球确诊病例超过 90 万例，死亡近 5 万例，2019 年冠状病毒病（COVID-19）大流行成为一场前所未有的医疗保健危机。COVID-19 的传播存在异质性，导致一些地区呈散发传播，COVID-19 住院患者相对较少，而另一些地区则出现社区传播，导致大量重症病例。对于这些地区，由于诊断检测、医院床位、呼吸机和感染病毒的医护人员等关键资源严重短缺，医疗服务受到严重干扰和破坏，而个人防护设备的短缺使情况进一步恶化。虽然轻症病例类似于常见的上呼吸道病毒感染，但随着疾病的进展，呼吸功能障碍成为发病率和死亡率的主要来源。胸部 X 线摄影和 CT 等胸部影像学检查是肺部疾病诊断和管理的关键工具，但在考虑疾病严重程度、呼吸道疾病的预测试概率、疾病进展的危险因素以及关键资源限制等多种因素的情况下，它们在 COVID-19 管理中的作用尚未得到充分考虑。为了弥补这一不足，一个由来自 10 个国家的放射科医生和肺病专家组成的多学科小组，在各种医疗保健环境中管理了一系列 COVID-19 患者，对影像学在三种不同风险因素、社区情况和资源限制下的应用价值进行了评估。该小组根据胸部影像学预期提供的信息的预期价值，对代表不同风险因素、社区条件和资源限制的三种情况下的 14 个关键问题（对应三种情况中的 11 个决策点和另外三个临床情况）进行了评分。结果进行了汇总，得出了五个主要建议和三个额外建议，旨在为临床医生提供指导，以帮助他们在 COVID-19 管理中使用胸部 X 线摄影和 CT。
