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Use of Chest Imaging in the Diagnosis and Management of COVID-19: A WHO Rapid Advice Guide
Elie A Akl1, Ivana Blažić1, Sally Yaacoub1
1From the Department of Internal Medicine (E.A.A.), Clinical Research Institute (S.Y.), Department of Emergency Medicine (E.H.), and Department of Pathology and Laboratory Medicine (R.M.), American University of Beirut, Beirut, Lebanon; Clinical Hospital Centre Zemun, Belgrade, Serbia (I.B.); Paris Descartes University, Paris, France (G.F.); Oregon Health & Science University, Portland, Ore (R.C.); Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (J.A.A.); Department of Imaging Informatics, Virtual University of Medical Sciences, Tehran, Iran (M.F.); L. Sacco, University Hospital, Milan, Italy (N.F.); WHO Patients for Patient Safety Program Advisory Group; Fatima Jinnah Medical University, Lahore, Pakistan (H.J.); Department of Radiology, PUMC Hospital Beijing, Beijing, China (Z.Y.J.); Department of Diagnostic and Interventional Radiology; Translational Pneumology, Heidelberg University Hospital, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.); Ernest Cook Ultrasound Research and Education Institute, Kampala, Uganda (M.K.); Departments of Radiology and Internal Medicine, University of Michigan/Michigan Medicine, Ann Arbor, Mich (E.A.K.); Department of Radiology, NYU Langone Health, New York, NY (J.P.K.); Imaging, Radiation Therapy and Oncohematology Department, Ribeirao Preto, Sao Paulo, Brazil (V.M.); Radiology Department, Kenyatta National Hospital, Nairobi, Kenya (R.N.); Radiology Department, CDI Hospital Clinic, University of Barcelona, Barcelona, Spain (M.S.); Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, Calif (P.B.S.); Imaging Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (M.U.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (C.Z.); Department of Environment, Climate Change and Health, Radiation and Health Unit (E.v.D., M.d.R.P.), World Health Organization, 20 ave Appia, 1211 Geneva 27, Switzerland.
Abstract:
The World Health Organization (WHO) undertook the development of a rapid guide on the use of chest imaging in the diagnosis and management of coronavirus disease 2019 (COVID-19). The rapid guide was developed over 2 months by using standard WHO processes, except for the use of "rapid reviews" and online meetings of the panel. The evidence review was supplemented by a survey of stakeholders regarding their views on the acceptability, feasibility, impact on equity, and resource use of the relevant chest imaging modalities (chest radiography, chest CT, and lung US). The guideline development group had broad expertise and country representation. The rapid guide includes three diagnosis recommendations and four management recommendations. The recommendations cover patients with confirmed or who are suspected of having COVID-19 with different levels of disease severity, throughout the care pathway from outpatient facility or hospital entry to home discharge. All recommendations are conditional and are based on low certainty evidence (n = 2), very low certainty evidence (n = 2), or expert opinion (n = 3). The remarks accompanying the recommendations suggest which patients are likely to benefit from chest imaging and what factors should be considered when choosing the specific imaging modality. The guidance offers considerations about implementation, monitoring, and evaluation, and also identifies research needs. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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