tetano
Editor, Senior Moderator
JRSM Open
. 2021 May 15;12(5):20542704211011837.
doi: 10.1177/20542704211011837. eCollection 2021 May.
Chest CT versus RT-PCR for the detection of COVID-19: systematic review and meta-analysis of comparative studies
Mohammad Karam[SUP] 1 [/SUP], Sulaiman Althuwaikh[SUP] 2 [/SUP], Mohammad Alazemi[SUP] 3 [/SUP], Ahmad Abul[SUP] 1 [/SUP], Amrit Hayre[SUP] 1 [/SUP], Abdulmalik Alsaif[SUP] 1 [/SUP], Gavin Barlow[SUP] 4 [/SUP]
Affiliations
Abstract
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.
Keywords: COVID-19; CT; RT-PCR; accuracy; sensitivity; specificity.
. 2021 May 15;12(5):20542704211011837.
doi: 10.1177/20542704211011837. eCollection 2021 May.
Chest CT versus RT-PCR for the detection of COVID-19: systematic review and meta-analysis of comparative studies
Mohammad Karam[SUP] 1 [/SUP], Sulaiman Althuwaikh[SUP] 2 [/SUP], Mohammad Alazemi[SUP] 3 [/SUP], Ahmad Abul[SUP] 1 [/SUP], Amrit Hayre[SUP] 1 [/SUP], Abdulmalik Alsaif[SUP] 1 [/SUP], Gavin Barlow[SUP] 4 [/SUP]
Affiliations
- PMID: 34035931
- PMCID: PMC8127597
- DOI: 10.1177/20542704211011837
Abstract
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.
Keywords: COVID-19; CT; RT-PCR; accuracy; sensitivity; specificity.