Category: Service delivery
Purpose:
Gastrointestinal symptoms are a presenting feature in as many as 20% of patients with SARS-CoV-2 infection. Patients with an acute surgical abdomen requiring operative intervention may also have incidental COVID-19. Studies suggest that computed tomography (CT) is 54% sensitive in detecting asymptomatic COVID-19. From 25 March 2020 the British Society of Gastrointestinal and Abdominal Radiology (BSGAR) and the British Society of Thoracic Imaging (BSTI) recommended opportunistic thoracic imaging in patients presenting emergently with an acute abdomen, where a decision for CT abdomen and pelvis had been made. We present data from our institution assessing the prevalence of COVID-19 detected by opportunistic CT thorax imaging.
Methods and materials:
A retrospective picture archiving communications system (PACS) search identified 148 patients presenting with acute abdomen to the emergency department between 27 March 2020 and 1 May 2020. Clinical history, imaging protocol, CT findings and virology data were compiled.
Results:
Of the 148 cases meeting criteria for CT thorax, 107/148 (72.2%) had an opportunistic CT thorax: five cases (4.7%) demonstrated probable CT features of COVID-19, of which one patient proceeded to have a polymerase chain reaction (PCR) test (negative). Four patients had indeterminate CT features, but only two of these four patients went on to have PCR tests, both of which were negative. Overall, 39/148 patients were swab tested (38 negative, one inadequate for analysis).
Conclusion:
This study detected a low prevalence of incidental CT features of COVID-19 in patients presenting with an acute abdomen. At our institution, opportunistic CT thorax imaging did not result in significantly greater detection of disease. Data from the first wave of infection allowed us to adapt our imaging protocol and better manage imaging demands for subsequent outbreaks.