Diagnostic Accuracy Of Serial Chest X-Ray As Good As Chest C
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This study aimed to evaluate the sensitivity, specificity, and severity of chest x-rays (CXR) and chest CTs over time in confirmed COVID-19+ and COVID-19- patients and to evaluate determinants of false negatives.

In a retrospective multi-institutional study, 254 RT-PCR verified COVID-19+ patients with at least one CXR or chest CT were compared with 254 age- and gender-matched COVID-19- controls. CXR severity, sensitivity, and specificity were determined with respect to time after onset of symptoms; sensitivity and specificity for chest CTs without time stratification. Performance of serial CXRs against CTs was determined by comparing area under the receiver operating characteristic curves (AUC).

Results:
-- COVID-19+ CXR severity and sensitivity increased with time (from sensitivity of 55% at less than 2 days to 79% at more than 11 days) whereas CXR specificity decreased over time (from 83% to 70%).
-- Serial CXR demonstrated increase in AUC (first CXR AUC=0.79, second CXR=0.87), and second CXR approached the accuracy of CT (AUC=0.92).
-- COVID-19 sensitivity of first CXR, second CXR, and CT was 73%, 83%, and 88%, whereas specificity was 80%, 73%, and 77%, respectively.
-- Normal and mild severity CXR findings were the largest factor behind false-negative CXRs (40% normal and 87% combined normal/mild).
-- Young age and African-American ethnicity increased false negative rates.

Conclusively, CXR sensitivity in COVID-19 detection increases with time, and serial CXRs of COVID-19+ patients has accuracy approaching that of chest CT.

Key takeaways:
- Sensitivity of CXR for COVID-19 increases from 55% at less than 2 days to 79% at more than 11 days after symptom onset.

- Accuracy of diagnosis of COVID-19 in serial CXR approaches that of chest CT.

- Normal or mild severity CXRs were the main determinants of false negative CXR interpretations.

Source: https://pubs.rsna.org/doi/10.1148/ryct.2020200337
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