Yield of Screening for COVID-19 in Asymptomatic Patients Before Elective or Emergency Surgery Using Chest CT and RT-PCR (SCOUT)
Carl A. J. Puylaert, Jochem C G Scheijmans, Alexander B.J. Borgstein, Caroline S. Andeweg, Annemarieke Bartels‐Rutten, Geerard L. Beets, Mark I. van Berge Henegouwen, Sicco J. Braak, Roy Couvreur, Freek Daams, Hendrik W. van Es, Lotte C. Franken, Brechtje A. Grotenhuis, Eduard R. Hendriks, Ignace H. J. T. de Hingh, Fieke Hoeijmakers, Joris T. ten Holder, Peter M. Huisman, Geert Kazemier, Floortje van Kesteren, Jurre van Kesteren, Kammy Keywani, Sara Z. Kuiper, Maurits Lange, Mark E. Lobatto, Arthur W. F. du Mée, Martijn Poeze, EM Meima-van Praag, Jorit van Rossen, Hjalmar C. van Santvoort, Wouter J. A. Sedee, Leonard W. F. Seelen, Sarah Sharabiany, Nico L. Sosef, Marian J.R. Quanjel, Jeroen Veltman, Tim Verhagen, Vincent C. J. van de Vlasakker, Pepijn D. Weeder, Jochem R. van Werven, Nina J. Wesdorp, Susan van Dieren, Alvin X. Han, Colin A. Russell, Menno D. de Jong, Patrick M. Bossuyt, Jet M.E. Quarles van Ufford, Mathias Prokop, Suzanne S. Gisbertz, Jan M. Prins, Marc G. Besselink, Marja A. Boermeester, Hester A. Gietema, Jaap Stoker
Abstract
OBJECTIVE: To determine the yield of preoperative screening for COVID-19 with chest CT and RT-PCR in patients without COVID-19 symptoms. SUMMARY OF BACKGROUND DATA: Many centers are currently screening surgical patients for COVID-19 using either chest CT, RT-PCR or both, due to the risk for worsened surgical outcomes and nosocomial spread. The optimal design and yield of such a strategy are currently unknown. METHODS: This multicenter study included consecutive adult patients without COVID-19 symptoms who underwent preoperative screening using chest CT and RT-PCR before elective or emergency surgery under general anesthesia. RESULTS: A total of 2093 patients without COVID-19 symptoms were included in 14 participating centers; 1224 were screened by CT and RT-PCR and 869 by chest CT only. The positive yield of screening using a combination of chest CT and RT-PCR was 1.5% [95% confidence interval (CI): 0.8-2.1]. Individual yields were 0.7% (95% CI: 0.2-1.1) for chest CT and 1.1% (95% CI: 0.6-1.7) for RT-PCR; the incremental yield of chest CT was 0.4%. In relation to COVID-19 community prevalence, up to ∼6% positive RT-PCR was found for a daily hospital admission rate >1.5 per 100,000 inhabitants, and around 1.0% for lower prevalence. CONCLUSIONS: One in every 100 patients without COVID-19 symptoms tested positive for SARS-CoV-2 with RT-PCR; this yield increased in conjunction with community prevalence. The added value of chest CT was limited. Preoperative screening allowed us to take adequate precautions for SARS-CoV-2 positive patients in a surgical population, whereas negative patients needed only routine procedures.