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Published on: December 19, 2020
[Korean Clinical Imaging Guidelines for Justification of Diagnostic Imaging Study for COVID-19]
Insights
Chest imaging is not recommended for diagnosing COVID-19 in asymptomatic patients. However, it may aid diagnosis with symptoms, guide hospital admission, and inform treatment for confirmed COVID-19 cases.
Area of Science:
- Infectious Diseases
- Radiology
- Pulmonology
Context:
- Developing evidence-based guidelines for COVID-19 diagnosis and management.
- Addressing the appropriate use of chest imaging in the context of the COVID-19 pandemic.
- Adapting international guidelines for Korean clinical practice.
Purpose:
- To establish Korean guidelines for the justification of chest imaging in coronavirus disease (COVID-19).
- To provide evidence-based recommendations on when to utilize chest radiography or CT scans for COVID-19 patients.
- To optimize diagnostic and treatment pathways using imaging in COVID-19 management.
Summary:
- Chest imaging is not indicated for asymptomatic COVID-19 patients.
- Imaging may be considered for symptomatic patients when PCR testing is unavailable, delayed, or negative.
- Chest imaging can inform hospital admission decisions for confirmed COVID-19 cases and guide treatment modifications in hospitalized patients.
- CT angiography is recommended for suspected pulmonary embolism or hemoptysis in COVID-19 patients.
- Imaging is not advised for discharge decisions but may help assess post-recovery functional impairment.
Impact:
- Aims to reduce unnecessary imaging, optimize resource allocation, and improve patient care pathways for COVID-19.
- Provides clear recommendations for clinicians on the judicious use of chest imaging in various COVID-19 scenarios.
- Contributes to standardized and evidence-based management of COVID-19 in South Korea.
Abstract:
To develop Korean coronavirus disease (COVID-19) chest imaging justification guidelines, eight key questions were selected and the following recommendations were made with the evidence-based clinical imaging guideline adaptation methodology. It is appropriate not to use chest imaging tests (chest radiograph or CT) for the diagnosis of COVID-19 in asymptomatic patients. If reverse transcription-polymerase chain reaction testing is not available or if results are delayed or are initially negative in the presence of symptoms suggestive of COVID-19, chest imaging tests may be considered. In addition to clinical evaluations and laboratory tests, chest imaging may be contemplated to determine hospital admission for asymptomatic or mildly symptomatic unhospitalized patients with confirmed COVID-19. In hospitalized patients with confirmed COVID-19, chest imaging may be advised to determine or modify treatment alternatives. CT angiography may be considered if hemoptysis or pulmonary embolism is clinically suspected in a patient with confirmed COVID-19. For COVID-19 patients with improved symptoms, chest imaging is not recommended to make decisions regarding hospital discharge. For patients with functional impairment after recovery from COVID-19, chest imaging may be considered to distinguish a potentially treatable disease.
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