scholarly journals The broad spectrum of COVID-like patients initially negative at RT-PCR testing: a cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Valeria Caramello ◽  
Alessandra Macciotta ◽  
Fabrizio Bar ◽  
Alessandro Mussa ◽  
Anna Maria De Leo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Hospital Stay ◽  
Clinical Judgment ◽  
Lung Ultrasound ◽  
Univariate Analysis ◽  
False Negative ◽  
Rt Pcr ◽  
Microbiological Testing ◽  
Tomography Scan

Abstract Background Patients that arrive in the emergency department (ED) with COVID-19-like syndromes testing negative at the first RT-PCR represent a clinical challenge because of the lack of evidence about their management available in the literature. Our first aim was to quantify the proportion of patients testing negative at the first RT-PCR performed in our Emergency Department (ED) that were confirmed as having COVID-19 at the end of hospitalization by clinical judgment or by any subsequent microbiological testing. Secondly, we wanted to identify which variables that were available in the first assessment (ED variables) would have been useful in predicting patients, who at the end of the hospital stay were confirmed as having COVID-19 (false-negative at the first RT-PCR). Methods We retrospectively collected data of 115 negative patients from2020, March 1st to 2020, May 15th. Three experts revised patients’ charts collecting information on the whole hospital stay and defining patients as COVID-19 or NOT-COVID-19. We compared ED variables in the two groups by univariate analysis and logistic regression. Results We classified 66 patients as COVID-19 and identified the other 49 as having a differential diagnosis (NOT-COVID), with a concordance between the three experts of 0.77 (95% confidence interval (95%CI) 0.66- 0.73). Only 15% of patients tested positive to a subsequent RT-PCR test, accounting for 25% of the clinically suspected. Having fever (odds ratio (OR) 3.32, (95%CI 0.97-12.31), p = 0.06), showing a typical pattern at the first lung ultrasound (OR 6.09, (95%CI 0.87-54.65), p = 0.08) or computed tomography scan (OR 4.18, (95%CI 1.11-17.86), p = 0.04) were associated with a higher probability of having COVID-19. Conclusions In patients admitted to ED with COVID-19 symptoms and negative RT-PCR a comprehensive clinical evaluation integrated with lung ultrasound and computed tomography could help to detect COVID-19 patients with a false negative RT-PCR result.

Pseudodiagnosis of Pseudoseizure

2020 ◽  
pp. 105-110
Author(s):  
Pat Croskerry
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
The Past ◽  
Autopsy Report ◽  
History Of ◽  
History Of Depression ◽  
Tomography Scan ◽  
Surprising Finding

In this case, a 35-year-old male is brought to a community hospital emergency department by ambulance having suffered an apparent seizure in the street. He is well known to the nurses and physician who see him. He has had several visits for seizures, and he has a history of depression. He has had electroencephalography studies and a computed tomography scan of his head in the past and has had assessments by both neurology and psychiatry. While he is in the department, he has an atypical seizure. There is a consensus among the ED staff that his seizures may be factitious. After a period of observation, he is discharged. Approximately 6 months later, the physician hears that the patient has died and tracks down his autopsy report, which had a surprising finding.

scholarly journals Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern

2017 ◽  
Vol 21 (9) ◽  
pp. 709-714 ◽  
Author(s):  
C. C. M. Marres ◽  
A. W. H. van de Ven ◽  
L. G. J. Leijssen ◽  
P. C. M. Verbeek ◽  
W. A. Bemelman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Anastomotic Leak ◽  
False Negative ◽  
Computed Tomography Scan ◽  
Tomography Scan

scholarly journals Evaluation of chest computed tomography features in COVID-19: a single-center retrospective study

2021 ◽  
Vol 4 (4) ◽  
pp. 588-594
Author(s):  
Akshat Sanjay Shukla ◽  
Sanjay Rajendraprasad Shukla ◽  
Feral Ravi Daruwala
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
False Negative ◽  
Chest Ct ◽  
Single Center ◽  
Rt Pcr ◽  
Pulmonary Vessel ◽  
Ct Findings ◽  
Diagnostic Center ◽  
Second Wave

Background: Even though Real-Time Polymerase Chain Reaction (RT-PCR) is a gold standard for confirming COVID-19, it continues to be plagued by a lack of RT-PCR kits and the potential of false-negative results. Hence, during the second wave of COVID-19 in India, Computed Tomography (CT) scan is an emerging diagnostic tool in evaluating the severity of illness in COVID-19 pneumonia. The present study endeavored to assess chest CT features of COVID-19 pneumonia in Indian population. Methods: This was a single-center, retrospective, observational study conducted in 300 consecutive adults RT-PCR confirmed COVID-19 patients from 1, Jan 2021 to 31, March 2021 at a private radio diagnostic center.  Data regarding baseline demographics, clinical and laboratory characteristics, extent, pattern, and type of abnormal CT findings were noted. Results: The study population (204 males and 108 females) had mean age of 43.18 ± 8.27 years.  Our study's most common clinical presentation was cough (48.1%) and fever (47.1%), respectively. Lung parenchymal abnormalities were found in 294 (94.2%) patients. Abnormal CT findings revealed the involvement of bilateral (45.6%) and multilobar (42.9%) with a predominant peripheral (92.3%) and posterior (80.8%) distribution. According to the type of opacity, Ground Glass Opacity (GGO) was the dominant abnormality found in 270 (91.8%) patients, in which pure GGO (36.7%), GGO with crazy paving pattern (39.8%), and GGO mixed with consolidation (52.0 %) were noted. Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was found in 192 (65.3 %) patients. Conclusion: During the second wave of COVID-19, a chest CT scan is a modality of choice in diagnosing COVID-19 pneumonia and related lung parenchymal changes.

scholarly journals Prediction Score for Cervical Spine Fracture in Patients with Traumatic Neck Injury

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Natsinee Athinartrattanapong ◽  
Chaiyaporn Yuksen ◽  
Sittichok Leela-amornsin ◽  
Chetsadakon Jenpanitpong ◽  
Sirote Wongwaisayawan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Cervical Spine ◽  
Spine Fracture ◽  
Prediction Score ◽  
Spine Injury ◽  
Cervical Spine Fracture ◽  
Clinical Prediction ◽  
Computed Tomography Scan ◽  
Tomography Scan

Background. Cervical spine fracture is approximately 2%–5%. Diagnostic imaging in developing countries has several limitations. A computed tomography scan is not available 24 hours and not cost-effective. This study aims to develop a clinical tool to identify patients who must undergo a computed tomography scan to evaluate cervical spine fracture in a noncomputed tomography scan available hospital. Methods. The study was a diagnostic prediction rule. A retrospective cross-sectional study was conducted between August 1, 2016, and December 31, 2018, at the emergency department. This study included all patients aged over 16 years who had suspected cervical spine injury and underwent a computed tomography scan at the emergency department. The predictive model and prediction scores were developed via multivariable logistic regression analysis. Results. 375 patients met the criteria. 29 (7.73%) presented with cervical spine fracture on computed tomography scan and 346 did not. Five independent factors (i.e., high-risk mechanism of injury, paraparesis, paresthesia, limited range of motion of the neck, and associated chest or facial injury) were considered good predictors of C-spine fracture. The clinical prediction score for C-spine fracture was developed by dividing the patients into three probability groups (low, 0; moderate, 1–5; and high, 6–11), and the accuracy was 82.52%. In patients with a score of 1–5, the positive likelihood ratio for C-spine fracture was 1.46. Meanwhile, those with a score of 6–11 had an LR+ of 7.16. Conclusion. In a noncomputed tomography scan available hospital, traumatic spine injuries patients with a clinical prediction score ≥1 were associated with cervical spine fracture and should undergo computed tomography scan to evaluate C-spine fracture.

Lazarus Redux

2020 ◽  
pp. 65-70
Author(s):  
Pat Croskerry
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Physical Examination ◽  
Respiratory Rate ◽  
Teaching Hospital ◽  
Emergency Physician ◽  
Cerebrovascular Accident ◽  
Stable Condition ◽  
Significant Drop ◽  
Tomography Scan

In this case, a 65-year-old male presents to the emergency department of a teaching hospital late in the evening with left-sided weakness that had started approximately 2 hours earlier. He also complains of mild pan-cranial headache and nausea, both of which started at the same time as the weakness. His physical examination is normal other than marked weakness and increased reflexes on the left side. A computed tomography scan is completed and appears normal. A referral is made to neurology describing the stable condition of the patient and the diagnosis of a non-hemorrhagic cerebrovascular accident. Medication is ordered for his nausea. Soon after, the patient becomes unresponsive with a significant drop in respiratory rate. The emergency physician assumes the patient is experiencing “a stroke in evolution” and calls neurology immediately. However, the diagnosis proves premature when another cause for the sudden deterioration of the patient is discovered.

scholarly journals Chest CT versus RT-PCR for the Detection of COVID-19: Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Mohammad Karam ◽  
Sulaiman Althuwaikh ◽  
Mohammad Alazemi ◽  
Ahmad Abul ◽  
Amrit Hayre ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Polymerase Chain Reaction ◽  
Meta Analysis ◽  
False Negative ◽  
Chest Ct ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Chest Computed Tomography ◽  
Polymerase Chain

AbstractPurposeTo compare the performance of chest computed tomography (CT) scan versus reverse transcription polymerase chain reaction (RT-PCR) in the initial diagnostic assessment of coronavirus disease 2019 (COVID-19) patients.MethodsA systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search of electronic information was conducted to identify all relevant studies comparing the diagnostic performance of chest CT scan versus RT-PCR in COVID-19 suspected cases. Sensitivity, specificity and accuracy were primary outcome measures. Secondary outcome measures included other test performance characteristics, discrepant findings between both investigations and main chest CT findings. Random effects modelling was used for the analyses.ResultsEight non-randomised retrospective studies enrolling 1910 patients were identified. Chest CT was more sensitive but less specific than RT-PCR. Accuracy was not statistically significantly different between chest CT and RT-PCR for the identification and exclusion of COVID-19 cases (Odds Ratio [OR] = 0.40, P = 0.15) in the context of hospitalised patients in a pandemic. Chest CT was shown to detect patients with false-negative RT-PCR results and true positives. Ground-glass opacities and consolidations were the most common chest CT manifestations.ConclusionsChest CT is not superior to RT-PCR for the initial detection of COVID-19 and has more false positives. It is likely to be useful in confirming COVID-19 in patients with a suspicious clinical presentation, but who have a false-negative SARS-CoV-2 RT-PCR test.Key Points‐Chest computed tomography (CT) is more sensitive but less specific in detecting and excluding coronavirus disease 2019 (COVID-19) when compared to reverse transcription polymerase chain reaction (RT-PCR).‐Accuracy of chest CT is not significantly different from RT-PCR for COVID-19 cases.‐Chest CT can detect false-negative and true-positive RT-PCR cases.

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