Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study

European Radiology Experimental

Andrea Cozzi¹  Serena Carriero²  Francesco Arpaia²  Gianmarco Della Pepa²  Simone Schiaffino³  Giovanni Di Leo³  Luca Alessandro Carbonaro³  Laura Menicagli³  Cristian Giuseppe Monaco³  Francesco Sardanelli⁴  Davide Astengo⁵  Alessandro Villa⁵  Federico Zaottini⁵  Ilan Rosenberg⁵ 

[1] Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy;Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy;Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy;Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy;Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy;Unit of Radiology, Ospedale Lavagna, Via Don Giovanni Battista Bobbio 25, 16033, Lavagna, Italy;

关键词: COVID-19;    COVID-19 diagnostic testing;    Diagnostic imaging;    Chest x-ray;    Severity score;   

DOI  :  10.1186/s41747-020-00195-w

来源: Springer

【 摘 要 】

BackgroundIntegration of imaging and clinical parameters could improve the stratification of COVID-19 patients on emergency department (ED) admission. We aimed to assess the extent of COVID-19 pulmonary abnormalities on chest x-ray (CXR) using a semiquantitative severity score, correlating it with clinical data and testing its interobserver agreement.MethodsFrom February 22 to April 8, 2020, 926 consecutive patients referring to ED of two institutions in Northern Italy for suspected SARS-CoV-2 infection were reviewed. Patients with reverse transcriptase-polymerase chain reaction positive for SARS-CoV-2 and CXR images on ED admission were included (295 patients, median age 69 years, 199 males). Five readers independently and blindly reviewed all CXRs, rating pulmonary parenchymal involvement using a 0–3 semiquantitative score in 1-point increments on 6 lung zones (range 0–18). Interobserver agreement was assessed with weighted Cohen’s κ, correlations between median CXR score and clinical data with Spearman’s ρ, and the Mann-Whitney U test.ResultsMedian score showed negative correlation with SpO2 (ρ = -0.242, p < 0.001), positive correlation with white cell count (ρ = 0.277, p < 0.001), lactate dehydrogenase (ρ = 0.308, p < 0.001), and C-reactive protein (ρ = 0.367, p < 0.001), being significantly higher in subsequently dead patients (p = 0.003). Considering overall scores, readers’ pairings yielded moderate (κ = 0.449, p < 0.001) to almost perfect interobserver agreement (κ = 0.872, p < 0.001), with better interobserver agreement between readers of centre 2 (up to κ = 0.872, p < 0.001) than centre 1 (κ = 0.764, p < 0.001).ConclusionsProposed CXR pulmonary severity score in COVID-19 showed moderate to almost perfect interobserver agreement and significant but weak correlations with clinical parameters, potentially furthering CXR integration in patients’ stratification.

【 授权许可】

CC BY