Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
Clin Radiol. 2021 May;76(5):384-390. doi: 10.1016/j.crad.2021.02.006. Epub 2021 Feb 23.
To report an audit of the evaluation of suspected, unconfirmed cases of COVID-19 including chest computed tomography (CT), as compared to World Health Organization recommendations.
A clinical audit was undertaken examining the evaluation of patients with suspected COVID-19 with negative SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) results, with comparison to WHO recommendations. A retrospective chart review was undertaken for 90 patients examining investigations, in particular CT, used to clarify the diagnosis.
Ninety patients underwent additional investigation. Seventy-five per cent adherence to WHO recommendations was observed. Fifty-two men (57.78%) and 38 (42.22%) women were investigated, with a median age of 69 years (range 20-96 years). Seventy-nine chest CT examinations demonstrated positive, indeterminate, and negative rates for COVID-19 of 3.79%, 24.1%, and 72.15% respectively. Three patients had discordant swab results with initially negative and subsequently positive results for SARS-CoV-2, resulting in false-negative rates of 5.1% for those retested. Combining discordant RT-PCR swab results, positive radiology, and patients treated as COVID-19-positive due to indeterminate radiology and highly consistent symptoms, resulted in a false-negative rate for initial SARS-CoV-2 RT-PCR swabs of 16.67%.
Seventy-five per cent compliance with relevant WHO guidance and a false-negative rate for initial swabs of 16.67% was demonstrated. Further evidence is needed to fully determine the utility of chest CT in the diagnosis of COVID-19 in the context of initial false-negative RT-PCR results.
报告一项对疑似、未经确认的 COVID-19 病例的评估，包括胸部计算机断层扫描（CT），与世界卫生组织的建议进行比较。
对怀疑患有 COVID-19 的患者进行临床审核，这些患者的 SARS-CoV-2 逆转录酶聚合酶链反应（RT-PCR）结果为阴性，与世界卫生组织的建议进行比较。对 90 名患者进行了回顾性图表审查，检查了用于明确诊断的检查，特别是 CT。
90 名患者接受了额外的检查。观察到 75%的患者遵循了世界卫生组织的建议。52 名男性（57.78%）和 38 名女性（42.22%）接受了调查，中位年龄为 69 岁（范围 20-96 岁）。79 次胸部 CT 检查显示 COVID-19 的阳性、不确定和阴性率分别为 3.79%、24.1%和 72.15%。3 名患者的拭子结果不一致，最初为 SARS-CoV-2 阴性，随后为阳性，导致重新检测的假阴性率为 5.1%。将不一致的 RT-PCR 拭子结果、阳性影像学和因不确定影像学和高度一致的症状而被视为 COVID-19 阳性的患者结合起来，导致初始 SARS-CoV-2 RT-PCR 拭子的假阴性率为 16.67%。
75%的患者符合相关世界卫生组织指南，初始拭子的假阴性率为 16.67%。需要进一步的证据来充分确定胸部 CT 在初始 RT-PCR 结果为假阴性的情况下对 COVID-19 诊断的应用价值。
