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Rizzetto F, Gnocchi G, Travaglini F, Di Rocco G, Rizzo A, Carbonaro LA, Vanzulli A. Impact of COVID-19 Pandemic on the Workload of Diagnostic Radiology: A 2-Year Observational Study in a Tertiary Referral Hospital. Acad Radiol 2023; 30:276-84. [PMID: 35781400 DOI: 10.1016/j.acra.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 01/11/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the impact of COVID-19 pandemic on diagnostic imaging workload in a tertiary referral hospital. MATERIALS AND METHODS Radiological examinations performed in pre-pandemic period (2015-2019) and in pandemic period (2020-2021) were retrospectively included. Based on epidemiological data and restriction measures, four pandemic waves were identified. For each of them, the relative change (RC) in workload was calculated and compared to the 5-year averaged workload in the corresponding pre-COVID-19 periods. Workload variations were also assessed according to technique (radiographs, CT, MRI, ultrasounds), body district (chest, abdomen, breast, musculoskeletal, head/neck, brain/spine, cardiovascular) and care setting (inpatient, outpatient, emergency imaging, pre-admission imaging). RESULTS A total of 1384380 examinations were included. In 2020 imaging workload decreased (RC = -11%) compared to the average of the previous 5 years, while in 2021 only a minimal variation (RC = +1%) was observed. During first wave, workload was reduced for all modalities, body regions and types of care setting (RC from -86% to -10%), except for CT (RC = +3%). In subsequent waves, workload increased only for CT (mean RC = +18%) and, regarding body districts, for breast (mean RC = +23%) and cardiovascular imaging (mean RC = +23%). For all other categories, a workload comparable to pre-pandemic period was almost only restored in the fourth wave. In all pandemics periods workload decrease was mainly due to reduced outpatient activity (p < 0.001), while inpatient and emergency imaging was increased (p < 0.001). CONCLUSION Evaluating imaging workload changes throughout COVID-19 pandemic helps to understand the response dynamics of radiological services and to improve institutional preparedness to face extreme contingency.
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Giraudo C, Librizzi G, Fichera G, Motta R, Balestro E, Calabrese F, Carretta G, Cattelan AM, Navalesi P, Pelloso M, Plebani M, Rea F, Vettor R, Vianello A, Stramare R. Reduced muscle mass as predictor of intensive care unit hospitalization in COVID-19 patients. PLoS One 2021; 16:e0253433. [PMID: 34138945 PMCID: PMC8211180 DOI: 10.1371/journal.pone.0253433] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate if reduced muscle mass, assessed with Computed Tomography (CT), is a predictor of intensive care unit (ICU) hospitalization in COVID-19 patients. Methods In this Institution Review Board approved study, we retrospectively evaluated COVID-19 patients treated in our tertiary center from March to November 2020 who underwent an unenhanced chest CT scan within three weeks from hospitalization.We recorded the mean Hounsfield Unit (Hu) value of the right paravertebral muscle at the level of the 12th thoracic vertebra, the hospitalization unit (ICU and COVID-19 wards), clinical symptoms, Barthel Index, and laboratory findings.Logistic regression analysis was applied to assess if muscle loss (Hu<30) is a predictor of ICU admission and outcome.Fisher’s exact and Student’s tests were applied to evaluate if differences between patients with and without muscle loss occurred (p<0.05). Results One-hundred-fifty patients matched the inclusion criteria (46 females; mean age±SD 61.3±15 years-old), 36 treated in ICU. Patients in ICU showed significantly lower Hu values (29±24 vs 39.4±12, p = 0.001). Muscle loss was a predictor of ICU admission (p = 0.004).Patients with muscle loss were significantly older (73.4±10 vs 56.4±14 years), had lower Barthel Index scores (54.4±33 vs 85.1±26), red blood-cell count (3.9±1 vs 4.6±1×1012L−1), and Hb levels (11.5±2 vs 13.2±2g/l) as well as higher white blood-cell count (9.4±7 vs 7.2±4×109L−1), C-reactive protein (71.5±71 vs 44±48U/L), and lactate dehydrogenase levels (335±163 vs 265.8±116U/L) (p<0.05, each). Conclusions Muscle loss seems to be a predictor of ICU hospitalization in COVID-19 patients and radiologists reporting chest CT at admission should note this finding in their reports.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine–DIMED, University of Padova, Padova, Italy
- * E-mail:
| | | | - Giulia Fichera
- Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Raffaella Motta
- Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Fiorella Calabrese
- Pathological Anatomy Section, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giovanni Carretta
- Unità Locale Socio Sanitaria–ULSS 3 Serenissima, Veneto Region, Italy
| | - Anna Maria Cattelan
- Division of Infectious and Tropical Diseases, Padova University Hospital, Padova, Italy
| | - Paolo Navalesi
- Anesthesiology and Intensive Care Unit, Department of Medicine–DIMED, University of Padova, Padova, Italy
| | - Michela Pelloso
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Roberto Vettor
- Internal Medicine, Department of Medicine—DIMED, University of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Roberto Stramare
- Department of Medicine–DIMED, University of Padova, Padova, Italy
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Calabrese F, Pezzuto F, Giraudo C, Vedovelli L, Fortarezza F, Del Vecchio C, Lunardi F, Fraia AS, Cocconcelli E, Vuljan SE, Gregori D, Crisanti A, Balestro E, Spagnolo P. The Diagnostic Yield of the Multidisciplinary Discussion in Patients With COVID-19 Pneumonia. Front Med (Lausanne) 2021; 8:637872. [PMID: 33869252 PMCID: PMC8047147 DOI: 10.3389/fmed.2021.637872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/03/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose: The hypothesis of the study was that a multidisciplinary approach involving experienced specialists in diffuse parenchymal lung disease might improve the diagnosis of patients with COVID-19 pneumonia. Methods: Two pulmonologists, two radiologists, and two pathologists reviewed 27 patients affected by severe COVID-19 pneumonia as the main diagnosis made by non-pulmonologists. To evaluate whether the contribution of specialists, individually and/or in combination, might modify the original diagnosis, a three-step virtual process was planned. The whole lung examination was considered the gold standard for the final diagnosis. The probability of a correct diagnosis was calculated using a model based on generalized estimating equations. The effectiveness of a multidisciplinary diagnosis was obtained by comparing diagnoses made by experienced pulmonologists with those made by non-pulmonologists. Results: In 19% of cases, the diagnosis of COVID-19-related death was mainly incorrect. The probability of a correct diagnosis increased strikingly from an undedicated clinician to an expert specialist. Every single specialist made significantly more correct diagnoses than any non-pulmonologist. The highest level of accuracy was achieved by the combination of 3 expert specialists (p = 0.0003). Conclusion: The dynamic interaction between expert specialists may significantly improve the diagnostic confidence and management of patients with COVID-19 pneumonia.
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Affiliation(s)
- Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Chiara Giraudo
- Department of Medicine, University of Padova, Medical School, Padova, Italy
| | - Luca Vedovelli
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Francesco Fortarezza
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Claudia Del Vecchio
- Department of Molecular Medicine, University of Padova, Medical School, Padova, Italy
| | - Francesca Lunardi
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Anna Sara Fraia
- Department of Medicine, University of Padova, Medical School, Padova, Italy
| | - Elisabetta Cocconcelli
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Stefania Edith Vuljan
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Andrea Crisanti
- Department of Molecular Medicine, University of Padova, Medical School, Padova, Italy
| | - Elisabetta Balestro
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
| | - Paolo Spagnolo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Medical School, Padova, Italy
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