Semi-quantitative visual assessment of chest radiography is associated with clinical outcomes in critically ill patients

Respiratory Research

Raul San Jose Estepar¹  Marta Vilas¹  Joshua A. Englert²  Mayra Pinilla-Vera³  Stefanie E. Mason³  Paul B. Dieffenbach³  Anthony F. Massaro³  Rebecca M. Baron³  Angelica Higuera³  George R. Washko³  Samuel Y. Ash³  Laura E. Fredenburgh³  Angela A. Rogers⁴ 

[1] Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School;Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University Wexner Medical Center;Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital;Department of Medicine, Division of Pulmonary, Critical Care Medicine, Stanford University School of Medicine;

关键词: Critical illness;    Hospital mortality;    Intensive care units;    Radiography;    Severity of illness index;   

DOI  :  10.1186/s12931-019-1201-0

来源: DOAJ

【 摘 要 】

Abstract Background Respiratory pathology is a major driver of mortality in the intensive care unit (ICU), even in the absence of a primary respiratory diagnosis. Prior work has demonstrated that a visual scoring system applied to chest radiographs (CXR) is associated with adverse outcomes in ICU patients with Acute Respiratory Distress Syndrome (ARDS). We hypothesized that a simple, semi-quantitative CXR score would be associated with clinical outcomes for the general ICU population, regardless of underlying diagnosis. Methods All individuals enrolled in the Registry of Critical Illness at Brigham and Women’s Hospital between June 2008 and August 2018 who had a CXR within 24 h of admission were included. Each patient’s CXR was assigned an opacification score of 0–4 in each of four quadrants with the total score being the sum of all four quadrants. Multivariable negative binomial, logistic, and Cox regression, adjusted for age, sex, race, immunosuppression, a history of chronic obstructive pulmonary disease, a history of congestive heart failure, and APACHE II scores, were used to assess the total score’s association with ICU length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, 60-day mortality, and overall mortality, respectively. Results A total of 560 patients were included. Higher CXR scores were associated with increased mortality; for every one-point increase in score, in-hospital mortality increased 10% (OR 1.10, CI 1.05–1.16, p < 0.001) and 60-day mortality increased by 12% (OR 1.12, CI 1.07–1.17, p < 0.001). CXR scores were also independently associated with both ICU length of stay (rate ratio 1.06, CI 1.04–1.07, p < 0.001) and duration of mechanical ventilation (rate ratio 1.05, CI 1.02–1.07, p < 0.001). Conclusions Higher values on a simple visual score of a patient’s CXR on admission to the medical ICU are associated with increased in-hospital mortality, 60-day mortality, overall mortality, length of ICU stay, and duration of mechanical ventilation.

【 授权许可】

Unknown