Comment on: Pre‐operative CT chest as a screening tool for COVID‐19: an appraisal of current evidence

Abstract

The use of chest CT as a preoperative tool is evolving as a useful adjunct in screening for COVID-19. However, this reflects collective evidence from the literature, including that on adult patients. Taking paediatric patients into consideration, the viewpoint appears to differ. The findings of COVID-19 in children were found to be different from those in adults, in that atypical features such as ground glass opacities were contained, with decreased attenuation, and thickening of the interlobular septa uncommonly noted. Steinberger et al. reported that the majority (77 per cent) of COVID-19 positive children had normal chest CT. Of note is the increase in positive findings on chest CT with increasing disease severity of the illness due to COVID-19. As regards the severity of COVID-19 in children, a systematic review documented that 21.9 per cent of COVID-19-positive children required hospitalization and only about 6.8 per cent needed intensive care. Further to this, the normalcy of chest CT in 30–50 per cent of COVID-positive children with milder symptoms raises concern about the use of chest CT as a screening tool before surgery. In select cases where the child presents with significant dyspnoea and features of Kawasaki disease/multisystem inflammatory syndrome, CT chest may be of use. The requirement for CT would mandate shifting of a child to a vulnerable area, unnecessarily risking exposure to COVID-19 infection. The ALARA (as low as reasonably achievable) principle of radiation in children is also of relevance. Careful deliberation of chest CT may need to be applied in paediatric patients who test positive for COVID-19, as most children seem to have milder features. It is clear that the evidence points to the questionable role of CT chest as a preoperative screening modality in paediatric surgical patients with COVID-19 infection. However, this may not be the case in children with symptoms, calling for a judicious balance between the risk of radiation and need for chest CT.