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COVID-19 diagnosed by CTA scan of stroke patients


Editor’s Note: Find the latest COVID-19 news and guidance from Medscape Coronavirus Resource Center..

Routine scan used to evaluate some Acute stroke According to a new study, patients can also detect SARS-CoV-2 infection in the upper lung.

Dr. Charles Esenwa

“As part of the stroke assessment work-up process, we were able to simultaneously diagnose COVID-19 at no additional cost or workload,” commented lead author Dr. Charles Esenwa. Medscape Medical News.. “This is an objective way to screen COVID-19 in an acute stroke setting,” he added.

Esenwa is an assistant professor and stroke neurologist at the Montefiore Medical Center / Albert Einstein Medical College in New York City.

He evaluated patients with severe acute stroke using computed tomography angiography (CTA) scans used to assess suitability for intravascular stroke treatment during the COVID-19 surge earlier this year. However, he explained that he showed upper lung findings consistent with viral infections. Some patients.

“Then, we assumed that these patients were infected with COVID-19 and took special precautions to maintain isolation and protect staff involved in care. Also, the COVID-19 swab test. I was able to triage these patients faster than waiting and arranging them. It’s the most appropriate care for them. “

Researchers have now returned to analyze their data on acute stroke patients who underwent CTA at their facility during the COVID-19 surge. They found that the changes identified in the lung were very specific for the diagnosis of SARS-CoV-2 infection.

Research Published online October 29th stroke..

“Stroke patients are usually screened for COVID-19 on admission, but it can take hours or more for the results of a cotton swab test to come back, and it is very difficult to know if a patient can become infected. It helps, “says Esenwa.

“When we do a CTA, we look at the blood vessels that supply the brain, but because it starts with the aortic arch, the scan also covers the upper part of the lungs. I notice signs of an active lung infection that may have been COVID-19. ” “In this paper, we’re back to evaluate how accurate this approach was actually compared to the COVID-19 PCR test.”

The researchers report 57 patients with acute symptoms at three Montefiore Health System hospitals in the Bronx, New York City. Ischemic stroke And those who received head and neck CTA in March and April 2020 are at the peak of COVID-19 outbreaks. The patient also underwent a PCR test for COVID-19.

The results showed that 30 patients had a positive COVID-19 test result and 27 had a negative result. Very high or very high suspicion of COVID-19 pneumonia, or very high lung findings, confirmed during CTA scan in 20 (67%) COVID-19-positive patients and 2 (7%) COVID-19-negative patients it was done.

These findings resulted in a sensitivity of 0.67 and a specificity of 0.93 when used alone. The diagnosis of COVID-19 had a positive predictive value of 0.19, a negative predictive value of 0.99, and an accuracy of 0.92.

Combining apical lung assessment with self-reported clinical symptoms of cough and dyspnea increased the diagnostic sensitivity of COVID-19 to 0.83 in patients who visited the hospital for acute ischemic stroke.

“I was wondering if looking at the whole lung would give better results, but other studies that did this actually found numbers similar to ours, so actually look at stroke CTA. I think you just look at the upper part of your lungs, which may be enough. “

He emphasized the importance of ascertaining whether acute stroke patients are infected with COVID-19. “If you have a high suspicion of COVID-19 infection, take additional precautions during procedures such as thrombectomy and then isolate the patient. It does not necessarily affect the treatment of stroke, but It affects the safety of patients and everyone who cares for them. “

Esenwa explained that intubation, which may be required during thrombectomy, can expose everyone in the room to aerosolized droplets. “Therefore, if a patient considers to be COVID-19 positive, he will take higher safety measures,” he said.

“Early diagnosis of COVID-19 also means that patients can receive supportive care more quickly and be admitted to the ICU as needed, and lung problems can be carefully monitored. Therefore, we have that information. That’s important in many ways, “he added.

Esenwa has evaluated a patent for acute stroke in thrombotomy and advises that medical centers experiencing a COVID-19 surge can use this method as a COVID-19 screening method.

He pointed out that the incidence of COVID-19 in the Montefiore Health System is very high. That part of New York City is one of the most devastated areas in the world, and CTA approaches to identify COVID-19 have only been validated in areas with very high COVID incidence. Accuracy may be reduced when used in areas with low prevalence.

“I’m not sure if this approach will work even when COVID-19 infection is low, where other conditions, such as pneumonia from other causes, are likely to cause lung findings. Congestive heart failure.. Therefore, false positives will increase. “

“But if the prevalence of COVID-19 is high, lung findings are much more likely to be a sign of COVID-19 infection. It is useful again because the number of COVID-19 is increasing again. It could be a strategy. “”

The study was approved by the Institutional Review Board of the Albert Einstein Medical College / Montefiore Medical Center and was not externally funded. Esenwa does not disclose any relevant financial relationships.

stroke. Published online on October 29, 2020. Full text

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