The Limited Sensitivity of Chest Computed Tomography Relative to Reverse Transcription Polymerase Chain Reaction for Severe Acute Respiratory Syndrome Coronavirus-2 Infection : A Systematic Review on COVID-19 Diagnostics
OBJECTIVES: Several studies suggest the sensitivity of chest computed tomography (CT) is far greater than that of reverse transcription polymerase chain reaction (RT-PCR) in diagnosing COVID-19 patients, and therefore, CT should be included as a primary diagnostic tool. This systematic review aims to stratify studies as high or low risk of bias to determine the true sensitivity of CT for severe acute respiratory syndrome coronavirus-2 infection according to the unbiased (low risk) studies, a topic of particular importance given the insufficient quantity of RT-PCR kits in many countries. We focus on sensitivity as that is the chief advantage perceived of CT.
MATERIALS AND METHODS: This systematic review involved searching the PubMed and Google Scholar databases for articles conducted and published between January 1 and April 15, 2020. The quality assessment tool QUADAS-2 was used to stratify studies according to their risk of bias, and exclusion criteria included not providing the information deemed relevant for such a stratification, such as not indicating if the patients were symptomatic or asymptomatic, or identifying the source of the specimen for the reference standard, RT-PCR (eg, nasal, oropharyngeal, etc). Sensitivity values were then extracted, and random effects meta-analyses were performed.
RESULTS: Of 641 search results, 37 studies (n = 9610 patients) were included in the analysis. The mean sensitivity of RT-PCR for COVID-19 reported by the biased studies was 70% (n = 5409/7 studies; 95% confidence interval [CI], 43-97; I = 99.1%), compared with 78% by unbiased studies (n = 534/4 studies; 95% CI, 69-87, I = 89.9%). For chest CT, the mean sensitivity reported by biased studies was 94% (n = 3371 patients/24 studies; 95% CI, 92-96; I = 93.1%), compared with 75% by unbiased studies (n = 957/10 studies; 95% CI, 67-83; I = 89.5%).
CONCLUSIONS: The difference between the sensitivities of CT and RT-PCR for severe acute respiratory syndrome coronavirus-2 infection is lower than previously thought, as after stratifying the studies, the true sensitivity for CT based on the unbiased studies is limited.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:55 |
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| Enthalten in: |
Investigative radiology - 55(2020), 12 vom: 17. Dez., Seite 754-761 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Waller, Joseph V [VerfasserIn] |
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| Anmerkungen: |
Date Completed 04.12.2020 Date Revised 29.03.2024 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/RLI.0000000000000700 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM311337333 |
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| 245 | 1 | 4 | |a The Limited Sensitivity of Chest Computed Tomography Relative to Reverse Transcription Polymerase Chain Reaction for Severe Acute Respiratory Syndrome Coronavirus-2 Infection |b A Systematic Review on COVID-19 Diagnostics |
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| 500 | |a Date Revised 29.03.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: Several studies suggest the sensitivity of chest computed tomography (CT) is far greater than that of reverse transcription polymerase chain reaction (RT-PCR) in diagnosing COVID-19 patients, and therefore, CT should be included as a primary diagnostic tool. This systematic review aims to stratify studies as high or low risk of bias to determine the true sensitivity of CT for severe acute respiratory syndrome coronavirus-2 infection according to the unbiased (low risk) studies, a topic of particular importance given the insufficient quantity of RT-PCR kits in many countries. We focus on sensitivity as that is the chief advantage perceived of CT | ||
| 520 | |a MATERIALS AND METHODS: This systematic review involved searching the PubMed and Google Scholar databases for articles conducted and published between January 1 and April 15, 2020. The quality assessment tool QUADAS-2 was used to stratify studies according to their risk of bias, and exclusion criteria included not providing the information deemed relevant for such a stratification, such as not indicating if the patients were symptomatic or asymptomatic, or identifying the source of the specimen for the reference standard, RT-PCR (eg, nasal, oropharyngeal, etc). Sensitivity values were then extracted, and random effects meta-analyses were performed | ||
| 520 | |a RESULTS: Of 641 search results, 37 studies (n = 9610 patients) were included in the analysis. The mean sensitivity of RT-PCR for COVID-19 reported by the biased studies was 70% (n = 5409/7 studies; 95% confidence interval [CI], 43-97; I = 99.1%), compared with 78% by unbiased studies (n = 534/4 studies; 95% CI, 69-87, I = 89.9%). For chest CT, the mean sensitivity reported by biased studies was 94% (n = 3371 patients/24 studies; 95% CI, 92-96; I = 93.1%), compared with 75% by unbiased studies (n = 957/10 studies; 95% CI, 67-83; I = 89.5%) | ||
| 520 | |a CONCLUSIONS: The difference between the sensitivities of CT and RT-PCR for severe acute respiratory syndrome coronavirus-2 infection is lower than previously thought, as after stratifying the studies, the true sensitivity for CT based on the unbiased studies is limited | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Systematic Review | |
| 700 | 1 | |a Allen, Isabel E |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Keldon K |e verfasserin |4 aut | |
| 700 | 1 | |a Diaz, Michael J |e verfasserin |4 aut | |
| 700 | 1 | |a Henry, Travis S |e verfasserin |4 aut | |
| 700 | 1 | |a Hope, Michael D |e verfasserin |4 aut | |
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