目的:预测COVID-19患者的预后非常重要,特别是在缺乏或缺乏患者分诊管理医疗资源的国家。目前,WHO指南建议,除了临床门诊评估外,还使用胸部影像学来决定家庭出院与住院之间的分诊。我们设计了我们的研究来验证这一建议,以指导临床医生。本研究为指导临床医生在2020年做出更好的决策提供了一些建议。
方法:在这项回顾性研究中,RT-PCR确诊的COVID-19患者(N=213)分为不同的临床和管理方案:家庭出院,病房住院和ICU入院。我们回顾了患者的初始胸部CT(如果有的话)。我们评估了CT的定量和定性特征以及相关的可用临床颈动脉数据。卡方,采用单因素方差分析和配对t检验进行分析。
结果:发现表明,大多数混合模式的患者,胸腔积液,涉及5个裂片,总评分≥10分,SpO2%≤90分,ESR(mm/h)≥60分,WBC(103/μL)≥8000分。大多数患者只有毛玻璃混浊,≤3瓣受累,外围分布,将SpO2%≥95,ESR(mm/h)<30和WBC(103/μL)<6000进行家庭排放。
结论:这项研究表明,除了初始临床门诊数据外,还使用初始胸部CT(定性和定量评估)可能是临床管理的一种有用的补充方法,并且对于临床医生来说是一种出色的决策工具(家庭出院与ICU/病房入院)。
OBJECTIVE: It is important to predict the COVID-19 patient\'s prognosis, particularly in countries with lack or deficiency of medical resource for patient\'s triage management. Currently, WHO guideline suggests using chest imaging in addition to clinicolaboratory evaluation to decide on triage between home-discharge versus hospitalization. We designed our study to validate this recommendation to guide clinicians. This study providing some suggestions to guide clinicians for better decision making in 2020.
METHODS: In this retrospective study, patients with RT-PCR confirmed COVID-19 (N = 213) were divided in different clinical and management scenarios: home-discharge, ward hospitalization and ICU admission. We reviewed the patient\'s initial chest CT if available. We evaluated quantitative and qualitative characteristics of CT as well as relevant available clinicolaboratory data. Chi-square, One-Way ANOVA and Paired t-test were used for analysis.
RESULTS: The finding showed that most patients with mixed patterns, pleural effusion, 5 lobes involved, total score ≥10, SpO2% ≤ 90, ESR (mm/h) ≥ 60 and WBC (103/μL) ≥ 8000 were hospitalized. Most patients with Ground-glass opacities only, ≤3 lobes involvement, peripheral distribution, SpO2% ≥ 95, ESR (mm/h) < 30 and WBC(103/μL) < 6000 were home-discharged.
CONCLUSIONS: This study suggests the use of initial chest CT (qualitative and quantitative evaluation) in addition to initial clinicolaboratory data could be a useful supplementary method for clinical management and it is an excellent decision making tool (home-discharge versus ICU/Ward admission) for clinicians.