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Brief Report

Diagnosis of COVID-19 in Patients with Negative Nasopharyngeal Swabs: Reliability of Radiological and Clinical Diagnosis and Accuracy Versus Serology

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Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Unit of Neurology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Unit of Laboratory Medicine, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Scientific Research Department, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Unit of Radiology, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
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Author to whom correspondence should be addressed.
These authors equally contributed to this work.
Membership of the CSS-COVID-19 Group is provided in the Acknowledgments.
Academic Editor: Carmen de Mendoza
Diagnostics 2021, 11(3), 386; https://doi.org/10.3390/diagnostics11030386
Received: 31 January 2021 / Revised: 16 February 2021 / Accepted: 22 February 2021 / Published: 25 February 2021
(This article belongs to the Section Diagnostic Microbiology and Infectious Disease)
Background: The diagnosis of Coronavirus disease 2019 (COVID-19) relies on the positivity of nasopharyngeal swab. However, a significant percentage of symptomatic patients may test negative. We evaluated the reliability of COVID-19 diagnosis made by radiologists and clinicians and its accuracy versus serology in a sample of patients hospitalized for suspected COVID-19 with multiple negative swabs. Methods: Admission chest CT-scans and clinical records of swab-negative patients, treated according to the COVID-19 protocol or deceased during hospitalization, were retrospectively evaluated by two radiologists and two clinicians, respectively. Results: Of 254 patients, 169 swab-confirmed cases and one patient without chest CT-scan were excluded. A total of 84 patients were eligible for the reliability study. Of these, 21 patients died during hospitalization; the remaining 63 underwent serological testing and were eligible for the accuracy evaluation. Of the 63, 26 patients showed anti-Sars-Cov-2 antibodies, while 37 did not. The inter-rater agreement was “substantial” (kappa 0.683) between radiologists, “moderate” (kappa 0.454) between clinicians, and only “fair” (kappa 0.341) between radiologists and clinicians. Both radiologic and clinical evaluations showed good accuracy compared to serology. Conclusions: The radiologic and clinical diagnosis of COVID-19 for swab-negative patients proved to be sufficiently reliable and accurate to allow a diagnosis of COVID-19, which needs to be confirmed by serology and follow-up. View Full-Text
Keywords: interstitial pneumonia; new coronavirus Sars-Cov-2; serologic test; sensitivity; specificity; chest CT-scan interstitial pneumonia; new coronavirus Sars-Cov-2; serologic test; sensitivity; specificity; chest CT-scan
MDPI and ACS Style

Mirijello, A.; Zarrelli, M.; Miscio, G.; de Matthaeis, A.; Piscitelli, P.; Carbonelli, C.M.; Di Giorgio, A.; Inglese, M.; Ciliberti, G.L.; Marciano, C.; Borelli, C.; Vergara, D.; Castorani, G.; Orciulo, G.V.; Di Mauro, L.; Carella, M.; Simeone, A.; Copetti, M.; Leone, M.A.; De Cosmo, S.; the CSS-COVID-Group. Diagnosis of COVID-19 in Patients with Negative Nasopharyngeal Swabs: Reliability of Radiological and Clinical Diagnosis and Accuracy Versus Serology. Diagnostics 2021, 11, 386. https://doi.org/10.3390/diagnostics11030386

AMA Style

Mirijello A, Zarrelli M, Miscio G, de Matthaeis A, Piscitelli P, Carbonelli CM, Di Giorgio A, Inglese M, Ciliberti GL, Marciano C, Borelli C, Vergara D, Castorani G, Orciulo GV, Di Mauro L, Carella M, Simeone A, Copetti M, Leone MA, De Cosmo S, the CSS-COVID-Group. Diagnosis of COVID-19 in Patients with Negative Nasopharyngeal Swabs: Reliability of Radiological and Clinical Diagnosis and Accuracy Versus Serology. Diagnostics. 2021; 11(3):386. https://doi.org/10.3390/diagnostics11030386

Chicago/Turabian Style

Mirijello, Antonio, Michele Zarrelli, Giuseppe Miscio, Angela de Matthaeis, Pamela Piscitelli, Cristiano M. Carbonelli, Annabella Di Giorgio, Michele Inglese, Gianluca L. Ciliberti, Carmen Marciano, Cristina Borelli, Doriana Vergara, Giulia Castorani, Grazia V. Orciulo, Lazzaro Di Mauro, Massimo Carella, Annalisa Simeone, Massimiliano Copetti, Maurizio A. Leone, Salvatore De Cosmo, and the CSS-COVID-Group. 2021. "Diagnosis of COVID-19 in Patients with Negative Nasopharyngeal Swabs: Reliability of Radiological and Clinical Diagnosis and Accuracy Versus Serology" Diagnostics 11, no. 3: 386. https://doi.org/10.3390/diagnostics11030386

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