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CT Scanning in Suspected Stroke or Head Trauma: Is it Worth Going the Extra Mile and Including the Chest to Screen
R M Kwee1, J Krdzalic2, B A C M Fasen2
1From the Department of Radiology (R.M.K., J.K., B.A.C.M.F., T.M.H.d.J.), Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands. rmkwee@gmail.com.
Insights
Additional chest CT scans can detect coronavirus disease 2019 (COVID-19) with high sensitivity but poor positive predictive value. Negative results do not rule out COVID-19, requiring PCR testing for confirmation.
Area of Science:
- Radiology
- Infectious Diseases
- Emergency Medicine
Background:
- Chest CT is a tool for rapid coronavirus disease 2019 (COVID-19) detection.
- Patients undergoing head CT for stroke or trauma in endemic regions may benefit from additional chest CT screening.
Purpose of the Study:
- To investigate the diagnostic value of additional chest CT for COVID-19 detection.
- To assess the sensitivity, specificity, and predictive values of chest CT in patients with suspected stroke or head trauma.
Main Methods:
- Included 27 patients undergoing head CT for suspected stroke or trauma.
- Performed additional chest CT for COVID-19 detection and RT-PCR testing.
- Calculated diagnostic performance metrics for chest CT.
Main Results:
- 7 of 27 patients (26%) had confirmed COVID-19 by RT-PCR.
- Chest CT showed 85.7% sensitivity, 75.0% specificity, 93.8% negative predictive value, and 54.6% positive predictive value.
- 20 of 27 patients presented with symptoms suggestive of COVID-19.
Conclusions:
- Additional chest CT has high sensitivity but poor positive predictive value for COVID-19 detection.
- A negative chest CT result does not exclude COVID-19.
- Correlation with clinical presentation and RT-PCR testing is essential for definitive diagnosis.
Background And Purpose:
Chest CT may be used as a tool for rapid coronavirus disease 2019 (COVID-19) detection. Our aim was to investigate the value of additional chest CT for detection of coronavirus 19 (COVID-19) in patients who undergo head CT for suspected stroke or head trauma in a COVID-19-endemic region.
Materials And Methods:
Our study included 27 patients (mean age, 74 years; range, 54-90 years; 20 men) who underwent head CT for suspected stroke (n = 21) or head trauma (n = 6), additional chest CT for COVID-19 detection, and real-time reverse transcriptase polymerase chain reaction testing in a COVID-19-endemic region. Sensitivity, specificity, and negative and positive predictive values of chest CT in detecting COVID-19 were calculated.
Results:
Final neurologic diagnoses were ischemic stroke (n = 11), brain contusion (n = 5), nontraumatic intracranial hemorrhage (n = 2), brain metastasis (n = 1), and no primary neurologic disorder (n = 8). Symptoms of possible COVID-19 infection (ie, fever, cough, and/or shortness of breath) were present in 20 of 27 (74%) patients. Seven of 27 patients (26%) had real-time reverse transcriptase polymerase chain reaction confirmed-COVID-19 infection. Chest CT results were 6 true-positives, 15 true-negatives, 5 false-positives, and 1 false-negative. Diagnostic performance values of chest CT were a sensitivity of 85.7%, specificity of 75.0%, negative predictive value of 93.8%, and positive predictive value of 54.6%.
Conclusions:
The sensitivity of additional chest CT is fairly high. However, a negative result does not exclude COVID-19. The positive predictive value is poor. Correlation of chest CT results with epidemiologic history and clinical presentation, along with real-time reverse transcriptase polymerase chain reaction, is needed for confirmation.
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