COVID-19 Stroke Apical Lung Examination Study (COVID SALES) [COVID-19]
Research type
Research Study
Full title
Radiological assessment of the lung apices for abnormalities consistent with Sars-CoV-2 infection in acute stroke CT studies
IRAS ID
284437
Contact name
Thomas C Booth
Contact email
Sponsor organisation
King's College London
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 7 months, 1 days
Research summary
Research Summary
Computed Tomography (CT) scans have shown pulmonary changes consistent with SARS-CoV-2 infection in those scanned for alternative diagnoses and in those with a low clinical suspicion for the virus. Sars-CoV-2 infection is pro-thrombotic with the potential for an increase in acute stokes. Anecdotally many acute stroke CT blood vessel imaging scans (known as CT angiography) contain changes consistent with Sars-CoV-2 infection in the lungs of patients hitherto unknown to have Sars-CoV-2 infection. However, there is no evidence determining the prevalence of lung changes consistent with Sars-CoV-2 infection, or the relationship between the extent of lung included on the scan and the sensitivity of detection.This observational study aims to assess the prevalence of pulmonary changes at the lung apices in patients attending London hospitals with acute stroke symptoms and signs, and undergoing acute stroke CT angiography. The patients will undergo routine care and only the patient information collected around the time of admission will be required.\n\nIt is likely that our study will (1) determine a quantifiable benefit of scrutinising the lung apices specifically during image review (often ignored as the focus is on the blood vessels in the neck and head) (2) inform policy and quantify whether increased coverage of the lung during an acute stroke CT angiogram would be beneficial (3) determine whether there are any implications for the need to perform routine swab testing (SARS-CoV-2 RT-PCR) of the patient if not already performed and (4) determine whether there are any implications for the use of personal protective equipment (PPE) in attending healthcare workers and isolation of the patient pending SARS-CoV-2 RT-PCR testing results.
Summary of Results
In total we studied 1,111 scans from patients who were suspected of having a stroke. The scans were called "Computed Tomographic Angiograms" and the finding on the scan we were studying called "Ground Glass Opacification" (GGO), was identified in 8.5%.
The finding of GGO is correctly diagnosed by different doctors. We measure this in scientific terms by saying it has "good inter-rater reliability". It also provides useful information on COVID infection. We measure this in scientific terms by saying it is a diagnostic biomarker with (1) high specificity (93.7%) i.e. a diagnosis of COVID is correct 93.7% of times. and (2) high negative predictive value (97.8%) i.e. a diagnosis of normal is correct 97.8% of times. In those patients who had been vaccinated patients, GGO remains a good diagnostic biomarker (specificity of 93.1% and negative predictive value of 99.7%).
We also found that patients with COVID-19 were more likely to have worse strokes: higher stroke severity scores, large artery occlusions, brain infarcts which are also large.
GGO was associated with patients being more unwell (known as worse functional outcome) on discharge and worse survival in one type of analysis.
REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
20/WM/0167
Date of REC Opinion
2 Jul 2020
REC opinion
Further Information Favourable Opinion