Apport de la TDM thoracique pour le dépistage de la COVID-19 et impact médico-économique de la pandémie à COVID-19 au service de radiologie de Fann (Dakar-Sénégal)
DOI:
https://doi.org/10.55715/jaim.v13i1.177Keywords:
COVID-19, Chest CT, Radiology, Economic impact, AfricaAbstract
Objectives: To evaluate the contribution of thoracic CT in the diagnosis of patients suspected of having COVID-19 in comparison with the reference technique (RT-PCR) and to determine the medico-economic impact of COVID-19 in the radiology department of the CHU of Fann.
Materials and methods: This was a retrospective, descriptive study over a 4-month period from April 1 to July 31, 2020, in the radiology department of the CHNU of Fann.
Patients were included if they were clinically suspected of having COVID-19, had a thoracic CT scan and a nasopharyngeal swab for RT-PCR, i.e. a total of 314 patients.
We studied epidemiological and clinical data, images suggestive of COVID-19 (ground glass opacities, condensation, lesion’ location), existence or not of embolism, abnormalities in favor of superinfection, associated lesions, impact on the attendance of the different modalities and impact on revenues.
Results: The median age was 62 years and the sex ratio 1.61. Fever was present in 7 patients (2.23%); cough in 17 patients (5.41%); dyspnea in 30 patients (9.55%) and respiratory distress syndrome in 63 patients (20.07%). The clinic was not specified in 163 patients (51.91%). Chest CT was normal in 20 patients (6.37%), suggestive of COVID-19 in 274 patients (87.26%) and not suggestive of COVID-19 in 20 patients (6.37%). RT-PCR was positive in 125 patients (39.80%). The sensitivity and specificity of CT were 91.2% and 15.34% respectively. The positive predictive value, the negative predictive value and the accuracy rate were respectively 42%, 72.5% and 45.5%. The decrease in attendance rate was 59% in standard radiography, 55% in ultrasound, 24% in CT and 87% in mammography. In our study there was a 40% decrease in revenue in the second quarter of 2020 compared to the first quarter.
Conclusion: Chest CT has a good sensitivity for the diagnosis of COVID-19. As such, it can be considered a primary tool for detecting lung lesions suggestive of COVID-19 pneumonia. The medico-economic impact of COVID-19 has been considerable.
RÉSUMÉ
Objectifs : Évaluer l’apport de la TDM thoracique dans le diagnostic des patients suspects de COVID-19 en comparaison avec la technique de référence (RT-PCR) et déterminer l’impact médico-économique de la COVID-19 au service de radiologie du CHU de Fann.
Matériels et méthodes : Il s’agissait d’une étude rétrospective, descriptive sur une période de 4 mois allant du 1er Avril au 31 Juillet 2020, au service de radiologie du CHU de Fann.
Ont été inclus les patients reçus pour suspicion clinique de COVID-19, qui avaient eu une TDM thoracique et un prélèvement naso-pharyngé par écouvillonnage pour RT-PCR, soit au total 314 patients. Nous avons étudié les données épidémiologiques, cliniques, les images évocatrices de COVID-19 (opacités en verre dépoli, condensation, topographie lésionnelle), existence ou non d’une embolie, les anomalies en faveur de surinfection, les lésions associées, l’impact sur la fréquentation des différentes modalités et l’impact sur les recettes.
Résultats : L’âge médian était de 62 ans et le sex-ratio 1,61. La fièvre a été présente chez 7 patients (2,23%) ; la toux chez 17 patients (5,41%) ; la dyspnée chez 30 patients (9,55%) et un syndrome de détresse respiratoire chez 63 patients (20,07%). La clinique n’a pas été précisée chez 163 patients (51,91%). La TDM thoracique était normale chez 20 patients (6,37%), évocatrice de COVID-19 chez 274 patients (87,26%) et non évocatrice de COVID-19 chez 20 patients (6,37%). La RT-PCR était positive chez 125 patients soit 39,80%. La sensibilité et la spécificité de la TDM étaient respectivement de 91,2% et 15,34%. La valeur prédictive positive, la valeur prédictive négative et le taux de précision étaient respectivement de 42%, 72,5% et 45,5%. La baisse du taux de fréquentation était de 59% en radiographie standard, 55% en échographie, 24% au scanner et 87% en mammographie. Dans notre étude on a noté une baisse de 40% des recettes au second trimestre de 2020 comparativement au premier trimestre.
Conclusion : La TDM thoracique a une bonne sensibilité pour le diagnostic de la COVID-19. De ce fait, elle peut être considérée comme un outil principal pour la détection des lésions pulmonaires évocatrices de pneumonie COVID-19. Les impacts médico-économiques de la COVID-19 ont été considérables.
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