The role for pre-operative CT chest scans in suspected COVID-19 patients requiring emergent surgery

Objective: To study the role for preoperative CT chest scans in suspected COVID-19 patients requiring emergent surgery. Design: Retrospective - observational. Participants: A total of 98 patients admitted for emergency surgery with COVID-19 infection and underwent preoperative CT chest scanning. Main outcome measurements: Incidence of clinical symptoms of COVID-19 infection upon presentation, imaging characteristics in chest CT and semi-quantitative CT severity score. Results: The median age of the study cohorts was 50 years (interquartile range (IQR): 40-60 years) and 52/98 (53.1%) were males. The most common symptoms were fever (80.6%) and cough (65.3%). 50/98 had positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR test prior to CT scan, while 48/98 had positive reverse transcriptase-polymerase chain reaction (RT-PCR) result returned after imaging. The imaging characteristics were bilateral infiltrates on CT of 90/98, with 70/98 of infiltrates located peripherally and 28/98 located peripherally and centrally. The most common disease pattern was ground-glass opacities, observed in 95/98. The median total COVID-19 CT severity score was 7 (IQR: 4-14), corresponding to 5-25% global lung involvement. Conclusion: Patients with mild symptomatic COVID-19 in this study displayed CT evidence of SARS-CoV-2 infection. Preoperative CT imaging should be considered for identifying suspected active SARS-CoV-2 cases in resource limited environments with high community spread, to aid in resource allocation and personal protective equipment (PPE) rationing.