Chest CT versus RT-PCR for the detection of COVID-19: systematic review and meta-analysis of comparative studies. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Karam, Mohammad; Althuwaikh, Sulaiman; Alazemi, Mohammad; Abul, Ahmad; Hayre, Amrit; Alsaif, Abdulmalik; Barlow, Gavin
• Is Part Of: JRSM open. Volume 12:Issue 5(2021)
• Publication Date: 2021-05
• Subjects: COVID-19 -- CT -- RT-PCR -- sensitivity -- specificity -- accuracy; Medicine -- Periodicals; Medicine -- Great Britain -- Periodicals; 610.5
• DOI: 10.1177/20542704211011837
• Languages: English
• ISSNs: 2054-2704

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.