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2020 ; 44
(8
): 1571-1580
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Thoracic computerised tomography scans in one hundred eighteen orthopaedic
patients during the COVID-19 pandemic: identification of chest lesions; added
values; help in managing patients; burden on the computerised tomography scan
department
#MMPMID32506142
Hernigou J
; Cornil F
; Poignard A
; El Bouchaibi S
; Mani J
; Naouri JF
; Younes P
; Hernigou P
Int Orthop
2020[Aug]; 44
(8
): 1571-1580
PMID32506142
show ga
PURPOSE: Based on the recent literature, chest computed tomography (CT)
examination could aid for management of patients during COVID-19 pandemic.
However, the role of chest CT in management of COVID-19 patients is not exactly
the same for medical or surgical specialties. In orthopaedic or trauma emergency,
abdomen, pelvis, cervical, dorsal, and lumbar spine CT are performed to
investigate patients; the result is a thoracic CT scan incorporating usually the
thorax; however, information about lung parenchyma can be obtained on this thorax
CT, and manifestations of COVID-19 can be diagnosed. The objective of our study
was to evaluate this role in orthopedic patients to familiarize orthopaedists
with the value and limits of thoracic CT in orthopaedic surgery. MATERIALS AND
METHODS: Among the 1397 chest CT scans performed during the pandemic period from
1 March 2020 to 10 May 2020, in two centres with orthopaedic surgery, we selected
all the 118 thoracic or chest CT performed for patients who presented to the
Emergency Department of the hospital with a diagnosis of trauma for orthopaedic
surgical treatment. Thirty-nine of these 118 patients were tested with PCR for
the diagnosis of COVID-19 infection. Depending on clinical status (symptomatic or
non-symptomatic), the information useful for the orthopaedist surgeon and
obtained from the Chest CT scan according to the result of the PCR (gold
standard) was graded from 0 (no or low value) to 3 (high value). The potential
risks of chest CT as exposure to radiation, and specific pathway were analyzed
and discussed. A group of patients treated during a previous similar period (1
March 2018 to 15 April 2018) was used as control for evaluation of the increase
of CT scanning during the COVID-19 pandemic. RESULTS: Among the 118 patients with
chest CT, there were 16 patients with positive COVID-19 chest CT findings, and
102 patients with negative chest CT scan. With PCR results as reference, the
sensitivity, specificity, positive predictive value of chest CT in indicating
COVID-19 infection were 81%, 93%, and 86%, respectively (p?=?0.001). A useful
information for the orthopaedic surgeon (graded as 1 for 71 cases, as 2 for 5
cases, and as 3 for 11 cases) was obtained from 118 chest CT scans for 87 (74%)
patients, while the CT was no value in 30 (25%) cases, and negative value in one
(1%) case. Roughly 20% of the total number of CT scanner performed over the
pandemic period was dedicated to COVID-19, but only 2% were for orthopaedic or
trauma patients. However, this was ten times higher than during the previous
control period of comparison. CONCLUSION: Although extremely valuable for surgery
management, these results should not be overstated. The CT findings studied are
not specific for COVID-19, and the positive predictive value of CT will be low
unless disease prevalence is high, which was the case during this period.