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Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study.

Abstract：

OBJECTIVES:To identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients. DESIGN:Retrospective analysis of electronic patient records. SETTING:Tertiary academic health science centre and designated centre for high consequence infectious diseases in London, UK. PARTICIPANTS:1198 patients who attended the emergency department with paired reverse transcriptase PCR (RT-PCR) swabs for SARS-CoV-2 and CXR between 16 March and 16 April 2020. MAIN OUTCOME MEASURES:Sensitivity and specificity of CXR and CT for diagnosis of COVID-19 using the British Society of Thoracic Imaging reporting templates. Reference standard was any RT-PCR positive naso-oropharyngeal swab within 30 days of attendance. ORs of CXR in association with vital signs, laboratory values and 30-day outcomes were calculated. RESULTS:Sensitivity and specificity of CXR for COVID-19 diagnosis were 0.56 (95% CI 0.51 to 0.60) and 0.60 (95% CI 0.54 to 0.65), respectively. For CT scans, these were 0.85 (95% CI 0.79 to 0.90) and 0.50 (95% CI 0.41 to 0.60), respectively. This gave a statistically significant mean increase in sensitivity with CT of 29% (95% CI 19% to 38%, p<0.0001) compared with CXR. Specificity was not significantly different between the two modalities.CXR findings were not statistically significantly or clinically meaningfully associated with vital signs, laboratory parameters or 30-day outcomes. CONCLUSIONS:CT has substantially improved diagnostic performance over CXR in COVID-19. CT should be strongly considered in the initial assessment for suspected COVID-19. This gives potential for increased sensitivity and considerably faster turnaround time, where capacity allows and balanced against excess radiation exposure risk.

journal_name

BMJ Open

journal_title

BMJ open

authors

Borakati A,Perera A,Johnson J,Sood T

doi

10.1136/bmjopen-2020-042946

subject

Has Abstract

pub_date

2020-11-06 00:00:00

pages

e042946

issue

11

issn

2044-6055

pii

bmjopen-2020-042946

journal_volume

10

pub_type

杂志文章

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