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. 2020 Dec;27(6):617-621.
doi: 10.1007/s10140-020-01808-y. Epub 2020 Jun 22.

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

The role of initial chest X-ray in triaging patients with suspected COVID-19 during the pandemic

Hyunjoong W Kim et al. Emerg Radiol. 2020 Dec.

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.

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Conflict of interest statement

Mary Salvatore, MD is a speaker and consultant for Genentech and Boehringer Ingelheim, and received grant funding from Genentech, Boehringer Ingelheim, and Lunglife AI.

Figures

Fig. 1
Fig. 1
Visual representation of the grading system for the chest radiographs, in which a grade 0 assigned for normal, b grade 1 assigned for alveolar opacities < 1/3 of lung, c grade 2 assigned for alveolar opacities 1/3 to 2/3 of lung, and d grade 3 assigned for alveolar opacities > 2/3 of lung
Fig. 2
Fig. 2
Overall survival curve for 410 patients
See this image and copyright information in PMC

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