Current best evidence for clinical care (more info)
OBJECTIVES: To compare the performance of chest computed tomography (CT) scan versus reverse transcription polymerase chain reaction (RT-PCR) as the reference standard in the initial diagnostic assessment of coronavirus disease 2019 (COVID-19) patients.
DESIGN: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A search of electronic information was conducted using the following databases: MEDLINE, EMBASE, EMCARE, CINAHL and the Cochrane Central Register of Controlled Trials.
SETTING: Studies that compared the diagnostic performance within the same patient cohort of chest CT scan versus RT-PCR in COVID-19 suspected patients.
PARTICIPANTS: Thirteen non-randomised studies enrolling 4092 patients were identified.
MAIN OUTCOME MEASURES: Sensitivity, specificity and accuracy were primary outcome measures. Secondary outcomes included other test performance characteristics and discrepant findings between both investigations.
RESULTS: Chest CT had a median sensitivity, specificity and accuracy of 0.91 (range 0.82-0.98), 0.775 (0.25-1.00) and 0.87 (0.68-0.99), respectively, with RT-PCR as the reference. Importantly, early small, China-based studies tended to favour chest CT versus later larger, non-China studies.
CONCLUSIONS: A relatively high false positive rate can be expected with chest CT. It is possible it may still be useful to provide circumstantial evidence, however, in some patients with a suspicious clinical presentation of COVID-19 and negative initial Severe Acute Respiratory Syndrome Coronavirus 2 RT-PCR tests, but more evidence is required in this context. In acute cardiorespiratory presentations, negative CT scan and RT-PCR tests is likely to be reassuring.
| Discipline / Specialty Area | Score |
|---|---|
| Infectious Disease | |
| Public Health | |
| Pediatric Emergency Medicine | |
| Emergency Medicine | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
Although CT can be used as an adjunct in ruling out COVID-19, it still has many limitations. It would be interesting to see CT's performance characteristics for outpatients (ie non-sick) as well as during non-pandemic times. The concern for false positives increasing as the findings can be non-specific, especially if there is not a clinical suspicion for COVID-19.
Useful information given the lack clarity in this area.