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. 2020 May 21.
doi: 10.3174/ajnr.A6607. Online ahead of print.

CT Scanning in Suspected Stroke or Head Trauma: Is It Worth to Go the Extra Mile and Include the Chest to Screen for COVID-19 Infection?

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CT Scanning in Suspected Stroke or Head Trauma: Is It Worth to Go the Extra Mile and Include the Chest to Screen for COVID-19 Infection?

R M Kwee et al. AJNR Am J Neuroradiol. .

Abstract

Background and purpose: Chest CT may be used as a tool for rapid coronavirus disease 2019 (COVID-19) detection. Our aim was to investigate the value of additional chest CT for detection of coronavirus 19 (COVID-19) in patients who undergo head CT for suspected stroke or head trauma in a COVID-19-endemic region.

Materials and methods: Our study included 27 patients (mean age, 74 years; range, 54-90 years; 20 men) who underwent head CT for suspected stroke (n = 21) or head trauma (n = 6), additional chest CT for COVID-19 detection, and real-time reverse transcriptase polymerase chain reaction testing in a COVID-19-endemic region. Sensitivity, specificity, and negative and positive predictive values of chest CT in detecting COVID-19 were calculated.

Results: Final neurologic diagnoses were ischemic stroke (n = 11), brain contusion (n = 5), nontraumatic intracranial hemorrhage (n = 2), brain metastasis (n = 1), and no primary neurologic disorder (n = 8). Symptoms of possible COVID-19 infection (ie, fever, cough, and/or shortness of breath) were present in 20 of 27 (74%) patients. Seven of 27 patients (26%) had real-time reverse transcriptase polymerase chain reaction confirmed-COVID-19 infection. Chest CT results were 6 true-positives, 15 true-negatives, 5 false-positives, and 1 false-negative. Diagnostic performance values of chest CT were a sensitivity of 85.7%, specificity of 75.0%, negative predictive value of 93.8%, and positive predictive value of 54.6%.

Conclusions: The sensitivity of additional chest CT is fairly high. However, a negative result does not exclude COVID-19. The positive predictive value is poor. Correlation of chest CT results with epidemiologic history and clinical presentation, along with real-time reverse transcriptase polymerase chain reaction, is needed for confirmation.

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