Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic.

OBJECTIVE: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. MATERIAL AND METHODS: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n = 535) and those in whom RT-PCR was not done because of low clinical suspicion (n = 443). RESULTS: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p = 0.22). CONCLUSION: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.

Utilidad de la radiografía de tórax para la detección de neumonía COVID 19 durante la pandemia por SARS-CoV-2 / Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic

Objetivo: Revisar la utilidad pronóstica de la radiografía de tórax en la selección de pacientes con sospecha de infección por SARS-CoV-2. Material y métodos: Estudio observacional, descriptivo y transversal, realizado en 978 pacientes con sospecha de infección por SARS-CoV-2 a los que se les hizo una radiografía de tórax en el servicio de urgencias de un hospital terciario, en marzo de 2020. Se analizaron variables demográficas, clínicas y pronósticas por separado en pacientes con RT-PCR (reacción en cadena de la polimerasa por transcriptasa inversa) hecha (grupo 1, n=535) o no hecha por baja sospecha clínica (grupo 2, n=443).Resultados: En el grupo 1 se observó una prevalencia de SARS-CoV-2 del 70,4%. La radiografía mostró una sensibilidad del 62,8%. En el grupo 2, la radiografía fue negativa en el 97,5%, corroborando la baja sospecha clínica, y fueron dados de alta; de ellos, el 5,6% volvió a consultar con formas leves de la enfermedad. En el grupo 1 no se observaron diferencias estadísticamente significativas en el porcentaje de radiografías de tórax patológicas entre los pacientes ingresados en plantas hospitalarias (68,3%) y los ingresados en la unidad de cuidados intensivos (72,9%), (p=0,22).Conclusión: En situación de pandemia, los pacientes con baja sospecha clínica y radiografía negativa pueden ser dados de alta con baja probabilidad de volver a consultar o de desarrollar formas graves de la enfermedad. En los pacientes con SARS-CoV-2 positivo, la radiografía de tórax inicial no tiene utilidad pronóstica.(AU)

Objective: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. Material and methods: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n=535) and those in whom RT-PCR was not done because of low clinical suspicion (n=443). Results: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p=0.22). Conclusion: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.(AU)

[Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic]. / Utilidad de la radiografía de tórax para la detección de neumonía COVID 19 durante la pandemia por SARS-CoV-2.

Objective: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. Material and methods: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n = 535) and those in whom RT-PCR was not done because of low clinical suspicion (n = 443). Results: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p = 0.22). Conclusion: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.

Comparación entre el «test combinado» y el «test combinado consecutivo» para la detección del síndrome de Down en el primer trimestre de la gestación / First trimester screening for Down syndrome. Comparation between «consecutive combined test» and «combined test»

Objetivos. Evaluar la eficacia del cribado del síndromede Down en el primer trimestre de la gestación comparandoel «test combinado consecutivo» con el «test combinado».Métodos. El «test combinado consecutivo» se ha ofrecidoa 10.080 mujeres embarazadas (edad materna [EM] 31,21± 4,95) y el «test combinado» o One Stop Clinics for Assessmentof Risk (OSCAR) a 1.535 (EM 31,14 ± 5,52). En el primergrupo, los marcadores bioquímicos (la subunidad β librede la gonadotrofina coriónica humana [fβhCG] y la proteínaplasmática A asociada al embarazo [PAPP-A]) se han determinadoentre las 7 y 12 semanas de gestación y la translucencianucal (TN) entre las 12 y las 13 semanas, mientrasque en el segundo grupo ambas determinaciones se hanefectuado en el mismo día, alrededor de la semana 12.Resultados. En el grupo «test combinado consecutivo», la tasa de falsos positivos fue de 1,90 % (192 embarazadas),significativamente menor al del grupo «test combinado»: 4,30 % (66 embarazadas). La tasa de detección fuedel 94,44 % (51/54) y del 94,52 % (69/73), respectivamente.La potencia discriminatoria de los múltiplos de la mediana(MoMs) de PAPP-A era mayor entre las semanas 8 y11, mientras que los de los MoMs de fβhCG y la TN a partirde la 13.Conclusiones. El «test combinado consecutivo» ennuestra serie de pacientes parece ser más eficiente que el«test combinado» al presentar una tasa de falsos positivosmenor con una tasa de detección similar, debido principalmenteal hecho de realizar los marcadores más sensibles(PAPP-A y TN) en el momento de su mayor eficacia (AU)

Objectives. To evaluate the performance of first-trimesterscreening for trisomy 21 comparing the «consecutivecombined test» in front of the «combined test».Methods. First-trimester «consecutive combinedtest» has been offered to 10,080 pregnant women (maternalage [MA] 31.21 ± 4.95) and the first-trimester «combinedtest» or One Stop Clinics for Assessment of Risk(OSCAR) to 1,535 pregnant women (MA 31.14 ± 5.52). Inthe first group, biochemical markers have been determinedat 7 to 12 weeks of gestation and the nuchal translucency(NT) at 12 to 13 weeks; meanwhile, in the secondgroup biochemical markers and NT have been determinedin the same day, close to 12 weeks.Results. In the first group (consecutive combinedtest) 10,080 pregnancies had been studied with a completefollow-up, with a screen positive rate of 1.91% (192pregnancies) and a detection rate of 94.44% (51/54Down syndrome pregnancies). In the second group (combinedtest) 1,535 pregnancies had been studied with acomplete follow-up, with a screen positive rate of 4.30%(66 pregnancies) and a detection rate of 94.52% (69/73Down syndrome pregnancies). Pregnancy-AssociatedPlasma Protein-A (PAPP-A) Multiples of the Median(MoMs) allows a better discriminatory power between 8and 11 weeks, meanwhile free β-chain of Human ChorionicGonadotropin (fβhCG) MoMs and NT MoMs allowsthis power after 13 week.Conclusion. The «consecutive combined test» appliedon our population seems to be more efficient with a lowerscreen positive rate than the «combined test» and asimilar detection rate, because the more sensitive markers(PAPP-A and NT) have been determined when theirpotential is higher (AU)