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      COVID-19: mobilising CT as a frontline management tool

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          Abstract

          As the COVID-19 pandemic has spread across the globe, questions have arisen about the approach healthcare systems should adopt in order to optimally manage patient influx. With a focus on the impact of COVID-19 on the NHS, we describe the frontline experience of a severely affected hospital in close proximity to London. We highlight a protocol-driven approach, incorporating the use of CT in the rapid triage, assessment and cohorting of patients, in an environment where there was a lack of readily available, onsite RT-PCR testing facilities. Furthermore, the effects of the protocol on the effective streamlining of patient flow within the hospital are discussed, as are the resultant improvements in clinical management decisions within the acute care service. This model may help other healthcare systems in managing this pandemic whilst assessing their own needs and resources.

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          Most cited references13

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          Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

          In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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            Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases

            Background Chest CT is used for diagnosis of 2019 novel coronavirus disease (COVID-19), as an important complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. Purpose To investigate the diagnostic value and consistency of chest CT as compared with comparison to RT-PCR assay in COVID-19. Methods From January 6 to February 6, 2020, 1014 patients in Wuhan, China who underwent both chest CT and RT-PCR tests were included. With RT-PCR as reference standard, the performance of chest CT in diagnosing COVID-19 was assessed. Besides, for patients with multiple RT-PCR assays, the dynamic conversion of RT-PCR results (negative to positive, positive to negative, respectively) was analyzed as compared with serial chest CT scans for those with time-interval of 4 days or more. Results Of 1014 patients, 59% (601/1014) had positive RT-PCR results, and 88% (888/1014) had positive chest CT scans. The sensitivity of chest CT in suggesting COVID-19 was 97% (95%CI, 95-98%, 580/601 patients) based on positive RT-PCR results. In patients with negative RT-PCR results, 75% (308/413) had positive chest CT findings; of 308, 48% were considered as highly likely cases, with 33% as probable cases. By analysis of serial RT-PCR assays and CT scans, the mean interval time between the initial negative to positive RT-PCR results was 5.1 ± 1.5 days; the initial positive to subsequent negative RT-PCR result was 6.9 ± 2.3 days). 60% to 93% of cases had initial positive CT consistent with COVID-19 prior (or parallel) to the initial positive RT-PCR results. 42% (24/57) cases showed improvement in follow-up chest CT scans before the RT-PCR results turning negative. Conclusion Chest CT has a high sensitivity for diagnosis of COVID-19. Chest CT may be considered as a primary tool for the current COVID-19 detection in epidemic areas. A translation of this abstract in Farsi is available in the supplement. - ترجمه چکیده این مقاله به فارسی، در ضمیمه موجود است.
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              A global clinical measure of fitness and frailty in elderly people.

              There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.
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                Author and article information

                Contributors
                Journal
                Br J Radiol
                Br J Radiol
                bjr
                The British Journal of Radiology
                The British Institute of Radiology.
                0007-1285
                1748-880X
                November 2020
                23 November 2020
                23 November 2020
                : 93
                : 1116
                : 20200522
                Affiliations
                [1 ]org-divisionDepartment of Radiology, Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon Hospital , Basildon, UK
                [2 ]org-divisionSchool of Clinical Medicine, University of Cambridge , Cambridge, UK
                [3 ]org-divisionAcute Medicine, University Hospitals Plymouth NHS Trust, Derriford Hospital , Plymouth, UK
                [4 ]org-divisionRespiratory Medicine, Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon Hospital , Basildon, UK
                [5 ]org-divisionAcute Medicine, Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon Hospital , Basildon, UK
                [6 ]org-divisionOlder People Medicine, Basildon and Thurrock University Hospital NHS Foundation Trust, Basildon Hospital , Basildon, UK
                Author notes
                Address correspondence to: Dr Sami Khan. E-mail: sami.khan@ 123456btuh.nhs.uk
                Author information
                https://orcid.org/0000-0003-4897-1941
                Article
                BJR-D-20-00522
                10.1259/bjr.20200522
                7716014
                33119424
                448ebacf-178b-48da-b0ad-4c9eaeb2adba
                © 2020 The Authors. Published by the British Institute of Radiology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License http://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

                History
                : 06 May 2020
                : 06 October 2020
                : 15 October 2020
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 16, Pages: 0, Words: 2763
                Categories
                Commentary
                bjr, BJR
                resp-trct, Respiratory tract

                Radiology & Imaging
                Radiology & Imaging

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