The choice of whether to use chest radiography (CXR) or computed tomography (CT) as a first-line imaging modality for the assessment of COVID-19 depends on factors that vary considerably among scenarios (e.g., local resources, expertise). In the context of the COVID-19 pandemic, imaging has turned out to be a valuable complementary tool to “rule-in” or “rule out” suspected COVID-19 patients, potentially accelerating the speed of diagnosis compared with RT-PCR dynamics. However, this method has some limitations: it is not universally available, turnaround times can be lengthy, and reported sensitivities vary (30–70%). The diagnosis of COVID-19 is based on the detection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) testing, most commonly of a nasopharyngeal swab. This infectious disease can result in a range of clinical outcomes, from an asymptomatic or mild flu-like illness to severe pneumonia, multiorgan failure, and even death. The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO 2 /FIO 2 ratio, and SpO 2 values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.Ĭoronavirus disease 2019 (COVID-19) has been declared a pandemic emergency by the World Health Organization on Ma.Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia.ConclusionsĬXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO 2/FiO 2 ratio, and SpO 2 values to early predict mortality and the need for ventilatory support. Percentage of lung involvement (OR: 1.02 95% CI: 1.01, 1.03 p = 0.001) and PaO 2/FiO 2 ratio (OR: 0.99 95% CI: 0.99, 1.00 p < 0.001) were significant predictors of the need for ventilatory support. The inter-rater agreement was almost perfect for type of parenchymal opacity ( κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). GGO admixed with consolidation ( n = 235, 69%) was the most common CXR finding. Predictors of death and respiratory support were identified by logistic or Poisson regression. Inter-rater agreement was assessed by weighted Cohen’s kappa ( κ) or intraclass correlation coefficient (ICC). Two scoring systems ( Brixia score and percentage of lung involvement) were applied. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. MethodsĪ total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1–13, 2020) were retrospectively included. To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support.
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