Suchá Dominika, van Hamersvelt Robbert W, van den Hoven Andor F, de Jong Pim A, Verkooijen Helena M
Department of Radiology (D.S., R.W.v.H., A.F.v.d.H., P.A.d.J., H.M.V.) and Imaging Division (H.M.V.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, the Netherlands.
Radiol Cardiothorac Imaging. 2020 Jul 30;2(4):e200342. doi: 10.1148/ryct.2020200342. eCollection 2020 Aug.
To synthesize the literature on diagnostic test accuracy of chest radiography, CT, and US for the diagnosis of coronavirus disease 2019 (COVID-19) in patients suspected of having COVID-19 in a hospital setting and evaluate the extent of suboptimal reporting and risk of bias.
A systematic search was performed (April 26, 2020) in EMBASE, PubMed, and Cochrane to identify chest radiographic, CT, or US studies in adult patients suspected of having COVID-19, using reverse-transcription polymerase chain reaction test or clinical consensus as the standard of reference. Two × two contingency tables were reconstructed, and test sensitivity, specificity, positive predictive values, and negative predictive values were recalculated. Reporting quality was evaluated by adherence to the Standards for Reporting of Diagnostic Accuracy Studies (STARD), and risk of bias was evaluated by adherence to the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).
Thirteen studies were eligible (CT = 12; chest radiography = 1; US = 0). Recalculated CT sensitivity and specificity ranged between 0.57 and 0.97, and 0.37 and 0.94, respectively, and positive predictive values and negative predictive values ranged between 0.59 and 0.92 and 0.57 and 0.96, respectively. On average, studies complied with only 35% of the STARD-guideline items. No study scored low risk of bias for all QUADAS-2 domains (patient selection, index test, reference test, and flow and timing). High risk of bias in more than one domain was scored in 10 of 13 studies (77%).
Reported CT test accuracy for COVID-19 diagnosis varies substantially. The validity and generalizability of these findings is complicated by poor adherence to reporting guidelines and high risk of bias, which are most likely due to the need for urgent publication of findings in the first months of the COVID-19 pandemic.© RSNA, 2020.
综合关于胸部X线摄影、CT和超声对医院环境中疑似新型冠状病毒肺炎（COVID-19）患者进行COVID-19诊断的诊断试验准确性的文献，并评估报告不充分的程度和偏倚风险。
于2020年4月26日在EMBASE、PubMed和Cochrane中进行系统检索，以识别疑似COVID-19的成年患者的胸部X线摄影、CT或超声研究，使用逆转录聚合酶链反应试验或临床共识作为参考标准。重建二乘二列联表，并重新计算试验敏感性、特异性、阳性预测值和阴性预测值。通过遵循诊断准确性研究报告标准（STARD）评估报告质量，通过遵循诊断准确性研究质量评估-2（QUADAS-2）评估偏倚风险。
13项研究符合要求（CT = 12；胸部X线摄影 = 1；超声 = 0）。重新计算的CT敏感性和特异性分别在0.57至0.97和0.37至0.94之间，阳性预测值和阴性预测值分别在0.59至0.92和0.57至0.96之间。平均而言，研究仅符合STARD指南项目的35%。没有一项研究在所有QUADAS-2领域（患者选择、索引试验、参考试验以及流程和时间）的偏倚风险评分为低风险。13项研究中的10项（77%）在多个领域的偏倚风险评分为高风险。
报告的CT对COVID-19诊断的试验准确性差异很大。这些结果的有效性和可推广性因对报告指南的遵循不佳和高偏倚风险而变得复杂，这很可能是由于在COVID-19大流行的最初几个月需要紧急发表研究结果。© RSNA，2020。
