使用胸部CT和逆转录聚合酶链反应（RT-PCR）在择期或急诊手术前对无症状患者进行2019冠状病毒病（COVID-19）筛查的产量（SCOUT）：多中心研究
Yield of Screening for COVID-19 in Asymptomatic Patients Before Elective or Emergency Surgery Using Chest CT and RT-PCR (SCOUT): Multicenter Study.
作者信息
Puylaert Carl A J, Scheijmans Jochem C G, Borgstein Alexander B J, Andeweg Caroline S, Bartels-Rutten Annemarieke, Beets Geerard L, van Berge Henegouwen Mark I, Braak Sicco J, Couvreur Roy, Daams Freek, van Es Hendrik W, Franken Lotte C, Grotenhuis Brechtje A, Hendriks Eduard R, de Hingh Ignace H J T, Hoeijmakers Fieke, Ten Holder Joris T, Huisman Peter M, Kazemier Geert, van Kesteren Floortje, van Kesteren Jurre, Keywani Kammy, Kuiper Sara Z, Lange Maurits D J, Lobatto Mark E, du Mée Arthur W F, Poeze Martijn, van Praag Elise M, van Rossen Jorit, van Santvoort Hjalmar C, Sedee Wouter J A, Seelen Leonard W F, Sharabiany Sarah, Sosef Nico L, Quanjel Marian J R, Veltman Jeroen, Verhagen Tim, van de Vlasakker Vincent C J, Weeder Pepijn D, van Werven Jochem R, Wesdorp Nina J, van Dieren Susan, Han Alvin X, Russell Colin A, de Jong Menno D, Bossuyt Patrick M M, Quarles van Ufford Jet M E, Prokop Mathias W, Gisbertz Suzanne S, Prins Jan M, Besselink Marc G, Boermeester Marja A, Gietema Hester A, Stoker Jaap
机构信息
Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
出版信息
Ann Surg. 2020 Dec;272(6):919-924. doi: 10.1097/SLA.0000000000004218.
OBJECTIVE
To determine the yield of preoperative screening for COVID-19 with chest CT and RT-PCR in patients without COVID-19 symptoms.
SUMMARY OF BACKGROUND DATA
Many centers are currently screening surgical patients for COVID-19 using either chest CT, RT-PCR or both, due to the risk for worsened surgical outcomes and nosocomial spread. The optimal design and yield of such a strategy are currently unknown.
METHODS
This multicenter study included consecutive adult patients without COVID-19 symptoms who underwent preoperative screening using chest CT and RT-PCR before elective or emergency surgery under general anesthesia.
RESULTS
A total of 2093 patients without COVID-19 symptoms were included in 14 participating centers; 1224 were screened by CT and RT-PCR and 869 by chest CT only. The positive yield of screening using a combination of chest CT and RT-PCR was 1.5% [95% confidence interval (CI): 0.8-2.1]. Individual yields were 0.7% (95% CI: 0.2-1.1) for chest CT and 1.1% (95% CI: 0.6-1.7) for RT-PCR; the incremental yield of chest CT was 0.4%. In relation to COVID-19 community prevalence, up to ∼6% positive RT-PCR was found for a daily hospital admission rate >1.5 per 100,000 inhabitants, and around 1.0% for lower prevalence.
CONCLUSIONS
One in every 100 patients without COVID-19 symptoms tested positive for SARS-CoV-2 with RT-PCR; this yield increased in conjunction with community prevalence. The added value of chest CT was limited. Preoperative screening allowed us to take adequate precautions for SARS-CoV-2 positive patients in a surgical population, whereas negative patients needed only routine procedures.
目的
确定对无新冠病毒病（COVID-19）症状患者进行胸部CT和逆转录聚合酶链反应（RT-PCR）术前筛查的阳性率。
背景资料摘要
由于手术结局恶化及医院内传播风险，目前许多中心使用胸部CT、RT-PCR或两者结合对手术患者进行COVID-19筛查。这种策略的最佳设计和阳性率目前尚不清楚。
方法
这项多中心研究纳入了连续的无COVID-19症状的成年患者，这些患者在全身麻醉下进行择期或急诊手术前接受了胸部CT和RT-PCR术前筛查。
结果
14个参与中心共纳入2093例无COVID-19症状的患者；1224例接受了CT和RT-PCR筛查，869例仅接受了胸部CT筛查。胸部CT和RT-PCR联合筛查的阳性率为1.5%[95%置信区间（CI）：0.8-2.1]。胸部CT的单独阳性率为0.7%（95%CI：0.2-1.1），RT-PCR的单独阳性率为1.1%（95%CI：0.6-1.7）；胸部CT的增量阳性率为0.4%。就COVID-19社区流行率而言，每10万居民每日入院率>1.5时，RT-PCR阳性率高达约6%，流行率较低时约为1.0%。
结论
每100例无COVID-19症状的患者中，有1例通过RT-PCR检测出严重急性呼吸综合征冠状病毒2（SARS-CoV-2）呈阳性；该阳性率随社区流行率增加而升高。胸部CT的附加价值有限。术前筛查使我们能够对手术人群中的SARS-CoV-2阳性患者采取适当的预防措施，而阴性患者仅需常规程序。
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