CT in relation to RT-PCR in diagnosing COVID-19 in The Netherlands: A prospective study

PLoS One. 2020 Jul 9;15(7):e0235844. doi: 10.1371/journal.pone.0235844. eCollection 2020.

Abstract

Introduction: Early differentiation between emergency department (ED) patients with and without corona virus disease (COVID-19) is very important. Chest CT scan may be helpful in early diagnosing of COVID-19. We investigated the diagnostic accuracy of CT using RT-PCR for SARS-CoV-2 as reference standard and investigated reasons for discordant results between the two tests.

Methods: In this prospective single centre study in the Netherlands, all adult symptomatic ED patients had both a CT scan and a RT-PCR upon arrival at the ED. CT results were compared with PCR test(s). Diagnostic accuracy was calculated. Discordant results were investigated using discharge diagnoses.

Results: Between March 13th and March 24th 2020, 193 symptomatic ED patients were included. In total, 43.0% of patients had a positive PCR and 56.5% a positive CT, resulting in a sensitivity of 89.2%, specificity 68.2%, likelihood ratio (LR)+ 2.81 and LR- 0.16. Sensitivity was higher in patients with high risk pneumonia (CURB-65 score ≥3; n = 17, 100%) and with sepsis (SOFA score ≥2; n = 137, 95.5%). Of the 35 patients (31.8%) with a suspicious CT and a negative RT-PCR, 9 had another respiratory viral pathogen, and in 7 patients, COVID-19 was considered likely. One of nine patients with a non-suspicious CT and a positive PCR had developed symptoms within 48 hours before scanning.

Discussion: The accuracy of chest CT in symptomatic ED patients is high, but used as a single diagnostic test, CT can not safely diagnose or exclude COVID-19. However, CT can be used as a quick tool to categorize patients into "probably positive" and "probably negative" cohorts.

MeSH terms

  • Adult
  • Aged
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / diagnostic imaging
  • Coronavirus Infections / epidemiology
  • Emergency Service, Hospital
  • Female
  • Humans
  • Likelihood Functions
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / diagnostic imaging
  • Pneumonia, Viral / epidemiology
  • Prospective Studies
  • Reverse Transcriptase Polymerase Chain Reaction
  • Tomography, X-Ray Computed

Grants and funding

The authors received no specific funding for this work.