tetano
Editor, Senior Moderator
Eur Radiol
. 2020 Oct 8.
doi: 10.1007/s00330-020-07270-1. Online ahead of print.
Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department
Maurizio Balbi[SUP] 1 2 [/SUP], Anna Caroli[SUP] 3 [/SUP], Andrea Corsi[SUP] 4 5 [/SUP], Gianluca Milanese[SUP] 6 [/SUP], Alessandra Surace[SUP] 4 5 [/SUP], Fabiano Di Marco[SUP] 7 8 [/SUP], Luca Novelli[SUP] 7 [/SUP], Mario Silva[SUP] 6 [/SUP], Ferdinando Luca Lorini[SUP] 9 [/SUP], Andrea Duca[SUP] 10 [/SUP], Roberto Cosentini[SUP] 10 [/SUP], Nicola Sverzellati[SUP] 6 [/SUP], Pietro Andrea Bonaffini[SUP] 4 5 [/SUP], Sandro Sironi[SUP] 4 5 [/SUP]
Affiliations
Abstract
Objectives: 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.
Methods: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression.
Results: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. 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). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support.
Conclusions: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio, and SpO[SUB]2[/SUB] values to early predict mortality and the need for ventilatory support.
Key points: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO[SUB]2[/SUB]/FIO[SUB]2[/SUB] ratio, and SpO[SUB]2[/SUB] values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.
Keywords: COVID-19; Radiography; Severe acute respiratory syndrome coronavirus 2.
. 2020 Oct 8.
doi: 10.1007/s00330-020-07270-1. Online ahead of print.
Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department
Maurizio Balbi[SUP] 1 2 [/SUP], Anna Caroli[SUP] 3 [/SUP], Andrea Corsi[SUP] 4 5 [/SUP], Gianluca Milanese[SUP] 6 [/SUP], Alessandra Surace[SUP] 4 5 [/SUP], Fabiano Di Marco[SUP] 7 8 [/SUP], Luca Novelli[SUP] 7 [/SUP], Mario Silva[SUP] 6 [/SUP], Ferdinando Luca Lorini[SUP] 9 [/SUP], Andrea Duca[SUP] 10 [/SUP], Roberto Cosentini[SUP] 10 [/SUP], Nicola Sverzellati[SUP] 6 [/SUP], Pietro Andrea Bonaffini[SUP] 4 5 [/SUP], Sandro Sironi[SUP] 4 5 [/SUP]
Affiliations
- PMID: 33033861
- DOI: 10.1007/s00330-020-07270-1
Abstract
Objectives: 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.
Methods: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression.
Results: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. 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). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support.
Conclusions: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO[SUB]2[/SUB]/FiO[SUB]2[/SUB] ratio, and SpO[SUB]2[/SUB] values to early predict mortality and the need for ventilatory support.
Key points: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO[SUB]2[/SUB]/FIO[SUB]2[/SUB] ratio, and SpO[SUB]2[/SUB] values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.
Keywords: COVID-19; Radiography; Severe acute respiratory syndrome coronavirus 2.