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

European Radiology Experimental

Andrea Cozzi¹  Gianmarco Della Pepa²  Francesco Arpaia²  Serena Carriero²  Laura Menicagli³  Giovanni Di Leo³  Francesco Sardanelli³  Simone Schiaffino³  Luca Alessandro Carbonaro³  Cristian Giuseppe Monaco³  Alessandro Villa⁴  Federico Zaottini⁴  Davide Astengo⁴  Ilan Rosenberg⁴ 

[1] Department of Biomedical Sciences for Health, Università degli Studi di Milano;Postgraduate School in Radiodiagnostics, Università degli Studi di Milano;Unit of Radiology, IRCCS Policlinico San Donato;Unit of Radiology, Ospedale Lavagna;

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: DOAJ

【 摘 要 】

Abstract Background Integration 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. Methods From 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. Results Median 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). Conclusions Proposed 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】

Unknown