Emerg Radiol . The Role of Initial Chest X-ray in Triaging Patients With Suspected COVID-19 During the Pandemic

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Emerg Radiol


. 2020 Jun 22.
doi: 10.1007/s10140-020-01808-y. Online ahead of print.
The Role of Initial Chest X-ray in Triaging Patients With Suspected COVID-19 During the Pandemic


Hyunjoong W Kim ¹ , K M Capaccione ² , Gen Li ³ , Lyndon Luk ² , Reginald S Widemon ² , Ozair Rahman ² , Volkan Beylergil ² , Ryan Mitchell ² , Belinda M D'Souza ² , Jay S Leb ² , Shifali Dumeer ² , Stuart Bentley-Hibbert ² , Michael Liu ² , Sachin Jambawalikar ² , John H M Austin ² , Mary Salvatore ²



Affiliations

• PMID: 32572707
• DOI: 10.1007/s10140-020-01808-y

Abstract

Purpose: The purpose of our research is to evaluate the usefulness of chest X-ray for triaging patients with suspected COVID-19 infection.
Methods: IRB approval was obtained to allow a retrospective review of adult patients who presented to the Emergency Department with a complaint of fever, cough, dyspnea or hypoxia and had a chest X-ray between 12 March 2020 and 26 March 2020. The initial chest X-ray was graded on a scale of 0-3 with grade 0 representing no alveolar opacities, grade 1: < 1/3 alveolar opacities of the lung, Grade 2: 1/3 to 2/3 lung with alveolar opacities and grade 3: > 2/3 alveolar opacities of the lung. Past medical history of diabetes and hypertension, initial oxygen saturation, COVID-19 testing results, intubation, and outcome were also collected.
Results: Four hundred ten patient chest X-rays were reviewed. Oxygen saturation and X-ray grade were both significantly associated with the length of stay in hospital, the hazard ratio (HR) of discharge was 1.05 (95% CI [1.01, 1.09], p = 0.017) and 0.61 (95% CI [0.51, 0.73], p < 0.001), respectively. In addition, oxygen saturation and X-ray grade were significant predictors of intubation (odds ratio (OR) of intubation is 0.88 (95% CI [0.81, 0.96], p = 0.004) and 3.69 (95% CI [2.25, 6.07], p < 0.001).
Conclusions: Initial chest X-ray is a useful tool for triaging those subjects who might have poor outcomes with suspected COVID-19 infection and benefit most from hospitalization.

Keywords: COVID-19; CXR; Chest; Coronavirus; SARS-CoV-2; X-ray.