Prodepêutica pulmonar em pacientes com Síndrome Respiratória Aguda Grave por SARS-COV-2: um estudo comparativo

Abstract

Introduction: Studies conducted in recent years have associated pulmonary auscultation and imaging patterns with the etiology of SARS-CoV-2 in patients with pneumonia. However, there is a need for studies to confirm and validate such diagnostic accuracy. Improving diagnostic suspicion with medical propaedeutics combined with imaging tests can bring clinical benefits in cases of difficulty in accessing the etiological diagnosis and even in the event of the advent of new strains that may be less detectable. Objective: This study seeks to associate the clinical and radiological propaedeutics of patients hospitalized with SARS with the etiological diagnosis, focusing on COVID-19. Materials and Methods: A cross-sectional observational study comparing pulmonary auscultation and radiological patterns on chest computed tomography (exposure factor) with the diagnosis of COVID-19 (outcome). To this end, the medical records of adult patients (≥ 18 years) hospitalized with SARS for at least 24 hours at the UFSCar University Hospital in 2020 were reviewed, with a confirmed or excluded diagnosis of COVID-19 by RT- PCR, with plain chest radiography or chest computed tomography in the 72 hours before or after admission. Pulmonary propaedeutics, radiographic and tomographic images were evaluated according to forms developed in the Redcap program. The calculated sample consisted of 42 clinical evaluations, 52 chest radiographs, and 96 tomographies. Patients were matched 1:1 by sex, date of admission, and age. Radiological images were analyzed by two evaluators. Results and conclusion: A total of 122 patients were included, with no significant differences between COVID-19 and non-COVID-19 patients in terms of pulmonary auscultation. Chest radiography was performed with the appropriate technique in only 53.8% of cases. The characteristics of plain chest radiography most associated with SARS-CoV-2 etiology were the presence of micronodules, involvement of the lower lateral region, and greater intensity of opacities. Chest computed tomography showed greater discrimination of etiological diagnosis in adult patients with SARS, with crazy paving opacities associated with COVID-19 and the finding of septal thickening not accompanied by ground glass and mediastinal adenomegaly associated with other etiologies. There was low agreement in the assessment of lung fields on plain chest radiography, which was better for assessing the mediastinum and costophrenic sinuses. There was moderate agreement in the assessment of tomographic images regarding the nature and distribution of lesions and the suspected etiological diagnosis.