key: cord-0703253-5k1i8up4
authors: Brennan, C.; Morrissey, B.; Dubois‐Marshall, S.; McAteer, D.; Qadir, A.; Ramsay, G.
title: COVID‐19: No benefit of chest inclusion in acute abdomen CT
date: 2020-08-13
journal: Br J Surg
DOI: 10.1002/bjs.11934
sha: 5a6de654b58736f8df958b8e7a49dd4afdaed045
doc_id: 703253
cord_uid: 5k1i8up4

nan

May). A COVID-19 score was allocated to the images, identifying those with radiological features of SARS-CoV-2. Imaging was then correlated with SARS-CoV-2 RT-PCR results. These images were re-reviewed with attention to lung base findings. A second data set in the same time-period was collected relating to all CT chest imaging. This set was collected to better appreciate the CT changes in COVID-19, and the proportion with lung base changes. A total of 212 patients had a CT Chest/Abdomen/Pelvis during the study timeframe. Out of these, twelve patients were identified radiologically as suspected COVID-19. Thus, 200 patients (95%) had a CT scan of their chest with no findings of SARS-CoV-2. This data highlights the low proportion of patients with the virus but does not shed light on the diagnostic significance of lung bases in the COVID-19 patient. Therefore the second data set was collected; the further analysis of CT Chest imaging. This set identified 77 patients with suspected COVID-19. In both cohorts, 98% of patients identified had changes visible in lung bases.

Assuming a prevalence of 5% in the community, the predicted sensitivity and specificity of CT chest is presented in Table 1 .

With the majority of symptoms being respiratory or coryzal, our data would suggest that routine additional CT chest adds little in the management of this pandemic in low prevalence areas.

Instead focused history and examination can be correlated with lung base findings.

Ultimately the goal is to deliver a complete surgical service for our patients without compromising safety 5 . Therefore, accepting a low disease prevalence, the addition of chest imaging has not significantly contributed to the identification of patients with COVID-19. These data have changed regional practice with NHS Grampian NHS Shetland and NHS Orkney no longer including thoracic imaging unless there is a high clinical suspicion, or if on review the lung bases are suggestive of COVID-19. Given the dynamic nature of this pandemic, and the resource strain, we feel that this is safe for patients, reduces radiation exposure and has a low false negative rate. 

Lung Base Findings of Coronavirus Disease (COVID-19) on Abdominal CT in Patients With Predominant Gastrointestinal Symptoms

Global guidance for surgical care during the COVID-19 pandemic