Acil Serviste COVID-19 Şüpheli Hastaların Polimeraz Zincir Reaksiyonu ve Bilgisayarlı Tomografi İnfiltrasyonları Arasındaki İlişki

Year 2024, Volume: 7 Issue: 2, 56 - 62, 29.06.2024

Saltuk Bugra Karaca , Betül Gülalp , Murat Muratoglu , Rahime Sezer , Hale Turnaoğlu , M. Şule Akçay , Elif Küpeli , Eylem Gül Ateş , Meriç Yavuz Çolak

https://doi.org/10.54996/anatolianjem.1438230

Abstract

Amaç: Acil Serviste (ED) Polimeraz Zincir Reaksiyonunun (PCR) sınırlamaları göz önüne alındığında, COVID-19'u değerlendirmek için alternatif doğrulama yöntemlerine ihtiyaç vardır. Bu çalışmanın amacı, Kuzey Amerika Radyoloji Derneği (RSNA) tavsiyelerine uygun olarak, pulmoner infiltrasyonları olan şüpheli COVID-19 hastaları için Toraks Bilgisayarlı Tomografisinin (T-BT) performansını değerlendirmektir.

Gereç ve Yöntemler: Mart-Ağustos 2020 tarihleri arasında, COVID-19 şüphesi olan 324 acil servis hastasına T-BT taraması yapılmıştır. Kör radyologlar, T-BT taramalarını RSNA kılavuzlarına göre bağımsız olarak değerlendirmiştir. Referans test olarak ters transkriptaz polimeraz zincir reaksiyonu (RT-PCR) kullanılmıştır.

Bulgular: 324 hastanın %35'inde RT-PCR testi pozitif çıkmıştır. T-CT kategorileri tipik (%35,2), belirsiz (%47,5) ve atipik (%11,1) olarak belirlenmiştir. Tipik T-CT kategori eşiğinin kullanılması %66 duyarlılık, %81 özgüllük, %65 pozitif prediktif değer (PPV), %82 negatif prediktif değer (NPV) ve %76 doğruluk ile sonuçlanmıştır. Tekrarlanan RT-PCR testlerinin alt grup analizi performansı iyileştirmiştir: %80 duyarlılık, %79 özgüllük, %76 PPV, %83 NPV ve %79 doğruluk. Acil serviste RT-PCR ve T-CT'nin birleştirilmesi %95,5 duyarlılık, %79 PPV ve %86,4 doğruluk sağlamıştır.

Sonuç: RSNA kılavuzları uyarınca, T-CT COVID-19'u tespit etmek için orta düzeyde hassasiyet ve yüksek özgüllük sergilemektedir. Şüpheli vakaların bulunduğu acil servis ortamlarında T-CT, ilk negatif RT-PCR sonucunun ardından yeniden test yapılmasını önermeye yardımcı olarak erken yönetimi ve zamanında izolasyon önlemlerini kolaylaştırır. RT-PCR ve T-CT'nin birlikte kullanımı tanısal performansı artırarak bu yöntemlerin entegre edilmesinin potansiyel faydalarını vurgulamaktadır.

Keywords

Bilgisayarlı Tomografi, COVID-19, Acil Servis, RT-PCR

The Relation of Polymerase Chain Reaction and Computed Tomography Infiltrations of Suspected Covid-19 Patients in Emergency Department

Abstract

Aim: Considering the limitations of Polymerase Chain Reaction (PCR) in the Emergency Department (ED), alternative confirmation methods for assessing COVID-19 are needed. This study aimed to evaluate the performance of Thorax-Computed Tomography (TCT), following Radiological Society of North America (RSNA) recommendations, for suspected COVID-19 patients with pulmonary infiltrations.

Material and Methods: From March to August 2020, 324 ED patients with suspected COVID-19 underwent T-CT scans. Blinded radiologists independently assessed T-CT scans based on RSNA guidelines. Reverse transcriptase polymerase chain reaction (RTPCR) served as the reference test.

Results: Of 324 patients, 35% tested positive via RT-PCR. T-CT categories were typical (35.2%), indeterminate (47.5%), and atypical (11.1%). Using a typical T-CT category threshold resulted in 66% sensitivity, 81% specificity, 65% positive predictive value (PPV), 82% negative predictive value (NPV), and 76% accuracy. Subgroup analysis of repeat RT-PCR tests improved performance: 80% sensitivity, 79% specificity, 76% PPV, 83% NPV, and 79% accuracy. Combining RT-PCR and T-CT in the ED achieved 95.5% sensitivity, 79% PPV, and 86.4% accuracy.

Conclusion: Following RSNA guidelines, T-CT exhibits moderatesensitivity and high specificity for detecting COVID-19. In EDsettings with suspected cases, T-CT aids in recommending retesting after an initial negative RT-PCR result, facilitating early management and timely isolation measures. The combined use of RT-PCR and T-CT enhances diagnostic performance, emphasizing the potential benefits of integrating these methods.

Keywords

Computed Tomography, COVID-19, emergency Department, RT-PCR

Ethical Statement

This retrospective study adhered to the ethical standards set by the institutional and national research committee, as well as the 1964 Helsinki Declaration and its subsequent amendments or comparable ethical guidelines. The study received approval from the Baskent University Local Ethics Committee (registration number: KA20/225).

Thanks

none

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