BACKGROUND: The diagnosis of Coronavirus disease 2019 (COVID-19) relies on the positivity of nasopharyngeal swab. However, a significant percentage of symptomatic patients may test negative. We evaluated the reliability of COVID-19 diagnosis made by radiologists and clinicians and its accuracy versus serology in a sample of patients hospitalized for suspected COVID-19 with multiple negative swabs. METHODS: Admission chest CT-scans and clinical records of swab-negative patients, treated according to the COVID-19 protocol or deceased during hospitalization, were retrospectively evaluated by two radiologists and two clinicians, respectively. RESULTS: Of 254 patients, 169 swab-confirmed cases and one patient without chest CT-scan were excluded. A total of 84 patients were eligible for the reliability study. Of these, 21 patients died during hospitalization; the remaining 63 underwent serological testing and were eligible for the accuracy evaluation. Of the 63, 26 patients showed anti-Sars-Cov-2 antibodies, while 37 did not. The inter-rater agreement was "substantial" (kappa 0.683) between radiologists, "moderate" (kappa 0.454) between clinicians, and only "fair" (kappa 0.341) between radiologists and clinicians. Both radiologic and clinical evaluations showed good accuracy compared to serology. CONCLUSIONS: The radiologic and clinical diagnosis of COVID-19 for swab-negative patients proved to be sufficiently reliable and accurate to allow a diagnosis of COVID-19, which needs to be confirmed by serology and follow-up.
BACKGROUND: The diagnosis of Coronavirus disease 2019 (COVID-19) relies on the positivity of nasopharyngeal swab. However, a significant percentage of symptomatic patients may test negative. We evaluated the reliability of COVID-19 diagnosis made by radiologists and clinicians and its accuracy versus serology in a sample of patients hospitalized for suspected COVID-19 with multiple negative swabs. METHODS: Admission chest CT-scans and clinical records of swab-negative patients, treated according to the COVID-19 protocol or deceased during hospitalization, were retrospectively evaluated by two radiologists and two clinicians, respectively. RESULTS: Of 254 patients, 169 swab-confirmed cases and one patient without chest CT-scan were excluded. A total of 84 patients were eligible for the reliability study. Of these, 21 patientsdied during hospitalization; the remaining 63 underwent serological testing and were eligible for the accuracy evaluation. Of the 63, 26 patients showed anti-Sars-Cov-2 antibodies, while 37 did not. The inter-rater agreement was "substantial" (kappa 0.683) between radiologists, "moderate" (kappa 0.454) between clinicians, and only "fair" (kappa 0.341) between radiologists and clinicians. Both radiologic and clinical evaluations showed good accuracy compared to serology. CONCLUSIONS: The radiologic and clinical diagnosis of COVID-19 for swab-negative patients proved to be sufficiently reliable and accurate to allow a diagnosis of COVID-19, which needs to be confirmed by serology and follow-up.
Authors: Constantine A Raptis; Mark M Hammer; Ryan G Short; Amar Shah; Sanjeev Bhalla; Andrew J Bierhals; Peter D Filev; Michael D Hope; Jean Jeudy; Seth J Kligerman; Travis S Henry Journal: AJR Am J Roentgenol Date: 2020-04-16 Impact factor: 3.959
Authors: A Tosoni; G Rizzatti; N Nicolotti; S Di Giambenedetto; G Addolorato; F Franceschi; L Zileri Dal Verme Journal: Eur Rev Med Pharmacol Sci Date: 2020-08 Impact factor: 3.507
Authors: Carla Maria Irene Quarato; Antonio Mirijello; Michele Maria Maggi; Cristina Borelli; Raffaele Russo; Donato Lacedonia; Maria Pia Foschino Barbaro; Giulia Scioscia; Pasquale Tondo; Gaetano Rea; Annalisa Simeone; Beatrice Feragalli; Valentina Massa; Antonio Greco; Salvatore De Cosmo; Marco Sperandeo Journal: Front Med (Lausanne) Date: 2021-07-19
Authors: Annabella Di Giorgio; Antonio Mirijello; Clara De Gennaro; Andrea Fontana; Paolo Emilio Alboini; Lucia Florio; Vincenzo Inchingolo; Michele Zarrelli; Giuseppe Miscio; Pamela Raggi; Carmen Marciano; Annibale Antonioni; Salvatore De Cosmo; Filippo Aucella; Antonio Greco; Massimo Carella; Massimiliano Copetti; Maurizio A Leone Journal: Diagnostics (Basel) Date: 2022-02-20
Authors: Cristiano Carbonelli; Angela de Matthaeis; Antonio Mirijello; Concetta Di Micco; Evaristo Maiello; Salvatore De Cosmo; Paolo Graziano Journal: Diagnostics (Basel) Date: 2021-05-18