Radiology. Clinical and Chest Radiography Features Determine Patient Outcomes In Young and Middle Age Adults with COVID-19

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Radiology. 2020 May 14:201754. doi: 10.1148/radiol.2020201754. [Epub ahead of print]
Clinical and Chest Radiography Features Determine Patient Outcomes In Young and Middle Age Adults with COVID-19.


Toussie D¹, Voutsinas N¹, Finkelstein M¹, Cedillo MA¹, Manna S¹, Maron SZ¹, Jacobi A¹, Chung M¹, Bernheim A¹, Eber C¹, Concepcion J¹, Fayad Z¹, Gupta YS¹.

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Abstract

Background Chest radiography (CXR) has not been validated for its prognostic utility in evaluating patients with coronavirus disease 2019 (COVID-19). Purpose The purpose of this study was to analyze the prognostic value of a CXR severity scoring system for younger (non-elderly) patients with COVID-19 upon initial presentation to the emergency department (ED). Outcomes of interest included hospitalization, intubation, prolonged stay, sepsis, and death. Materials & Methods In this retrospective study, patients between the ages of 21 and 50 years who presented to EDs of an urban multicenter health system from March 10 - 26, 2020 with COVID-19 confirmation on real-time reverse transcriptase polymerase chain reaction (RT-PCR) were identified. Each patient's ED CXR was divided into 6 zones and examined for opacities by two cardiothoracic radiologists with scores collated into a total concordant lung zone severity score. Clinical and laboratory variables were collected. Multivariable logistic regression was utilized to evaluate the relationship between clinical parameters, CXR scores, and patient outcomes. Results The study included 338 patients: 210 males (62%), median age 39 [31-45]. After adjustment for demographics and co-morbidities, independent predictors of hospital admission (n=145, 43%) were CXR severity score ≥ 2 (OR: 6.2, 95% CI 3.5-11, p<0.001) and obesity (OR 2.4 (1.1-5.4) or morbid obesity. Of patients who were admitted, a CXR score ≥3 was an independent predictor of intubation (n=28) (OR: 4.7, 95% CI 1.8-13, p=0.002) as was hospital site. We found no significant difference in primary outcomes across race/ethnicity, those with a history of tobacco use, asthma or diabetes mellitus type II. Conclusion For patients aged 21-50 with COVID-19 presenting to the emergency department, a chest x-ray severity score was predictive of risk for hospital admission and intubation.



PMID:32407255DOI:10.1148/radiol.2020201754