Front. Public HealthFrontiers in Public HealthFront. Public Health2296-2565Frontiers Media S.A.10.3389/fpubh.2021.748263Public HealthGeneral CommentaryCommentary: The Many Faces of COVID-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, ItalyAl KhalilAhmed1AbsiMarissa1IslamNayaar2EbrahimzadehSanam2McInnesMatthew D. F.3*1Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada2Department of Radiology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada3Department of Radiology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
Edited by: Amer Harky, Liverpool Heart and Chest Hospital, United Kingdom
Reviewed by: Amr Ashry, Assiut University, Egypt
*Correspondence: Matthew D. F. McInnes mmcinnes@toh.ca
This article was submitted to Infectious Diseases - Surveillance, Prevention and Treatment, a section of the journal Frontiers in Public Health
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A Commentary on The Many Faces of COVID-19 at a Glance: A University Hospital Multidisciplinary Account From Milan, Italy by Priori, A., Baisi, A., Banderali, G., Biglioli, F., Bulfamante, G., Canevini, M. P., Cariati, M., Carugo, S., Cattaneo, M., Cerri, A., Chiumello, D., Colosio, C., Cozzolino, M., D'Arminio Monforte, A., Felisati, G., Ferrari, D., Gambini, O., Gardinali, M., Marconi, A. M., Olivari, I., Orfeo, N. V., Opocher, E., Pietrogrande, L., Previtera, A., Rossetti, L., Vegni, E., Toschi, V., Zuin, M., and Centanni, S. (2021). Front. Public Health 8:575029. doi: 10.3389/fpubh.2020.575029COVID-19diagnostic accuracychest CTevidence-based medicineliving systematic review
We thank Priori et al. for their case study reporting the clinical, pathological, and radiological findings they observed in COVID-19 patients at their teaching hospital in Milan, Italy (1). The authors stated that chest CT has low specificity for COVID-19 infection in suspected patients and therefore cannot distinguish SARS-CoV2 infection from other respiratory diseases (1). This conclusion is based on the first version of a “Living” Cochrane Systematic Review on the diagnostic accuracy of imaging tests for COVID-19, published in September 2020, which identified that chest CT had a specificity of 18.1% [95% confidence interval (95% CI) 3.71–55.8] and sensitivity of 86.2% (95% CI 71.9–93.8) (2).
The “Living” Systematic Review strives to stay updated as new evidence emerges in this continuously evolving field of research. The second version of this review was published in November 2020 (3), and the third, most recent version, was published in March 2021 (4). In the latest version, the specificity of chest CT was 80.0% (95% CI 74.9–84.3) and the sensitivity was 87.9% (95% CI 84.6–90.6); the pooled estimates were drawn from 41 studies and 16,133 participants (4). The substantial rise in specificity can be possibly explained by the use of scoring systems (such as CO-RADS), which provide better definitions for index test positivity. Another explanation may be higher quality studies emerging later in the pandemic, benefitting from improved knowledge about COVID-19 (3). Additionally, the latest version includes an evaluation of the diagnostic accuracy of X-ray and ultrasound in COVID-19 infection (4). Our hope is that authors continue to prioritize transparent reporting and methodological rigor in future studies. The team conducting this Cochrane review will continuously aim to provide the most up to date evidence on the diagnostic accuracy of these imaging modalities.
Author Contributions
MA conceived and presented the idea. AA put the data together and presented it coherently into a draft manuscript. All authors took part in obtaining relevant accurate information and contributed to the final manuscript through editing and fact-checking.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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ReferencesPrioriABaisiABanderaliGBiglioliFBulfamanteGCaneviniMP. The many faces of covid-19 at a glance: a university hospital multidisciplinary account from Milan, Italy. Front Public Health. (2021) 8:575029. 10.3389/fpubh.2020.57502933490013SalamehJLeeflangMHooftLIslamNMcGrathTPolC. Thoracic imaging tests for the diagnosis of COVID-19. Cochrane Database Syst Rev. (2020) 9:2–6. 10.1002/14651858.CD013639.pub333242342IslamNSalamehJLeeflangMHooftLMcGrathTPolC. Thoracic imaging tests for the diagnosis of COVID-19 (update 1). Cochrane Database Syst Rev. (2020) 11:2–4.IslamNEbrahimzadehSSalamehJPKaziSFabianoNTreanorL. Thoracic imaging tests for the diagnosis of COVID-19 (update 2). Cochrane Database Syst Rev. (2021) 3:CD013639.