Diagnostic and Prognostic Value of Chest Radiographs for COVID-19 at Presentation
| Autor: | Sharon Amit, Eli Konen, Maximiliano Klug, Sara Apter, Ariel Kerpel, Edith M. Marom, Esther Houri-Levi, Noam Nissan |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Pleural effusion Intraclass correlation medicine.medical_treatment Radiography lcsh:Medicine law.invention 0302 clinical medicine COVID-19 Testing law Intubation Single-Blind Method 030212 general & internal medicine Lung Original Research Aged 80 and over Observer Variation lcsh:Medical emergencies. Critical care. Intensive care. First aid General Medicine Middle Aged Prognosis Intensive care unit medicine.anatomical_structure Area Under Curve Emergency Medicine Female Radiography Thoracic Radiology Presentation (obstetrics) Coronavirus Infections Adult medicine.medical_specialty Pneumonia Viral 03 medical and health sciences Betacoronavirus Clinical Decision Rules medicine Humans Endemic Infections Pandemics Aged Retrospective Studies Receiver operating characteristic business.industry Clinical Laboratory Techniques SARS-CoV-2 lcsh:R COVID-19 Reproducibility of Results 030208 emergency & critical care medicine lcsh:RC86-88.9 medicine.disease ROC Curve Case-Control Studies business |
| Zdroj: | Western Journal of Emergency Medicine, Vol 21, Iss 5 (2020) Western Journal of Emergency Medicine |
| ISSN: | 1936-9018 |
| Popis: | Introduction Pulmonary opacities in COVID-19 increase throughout the illness and peak after ten days. The radiological literature mainly focuses on CT findings. The purpose of this study was to assess the diagnostic and prognostic value of chest radiographs (CXR) for coronavirus disease 2019 (COVID-19) at presentation. Methods We retrospectively identified consecutive reverse transcription polymerase reaction-confirmed COVID-19 patients (n = 104, 75% men) and patients (n = 75, 51% men) with repeated negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests. Two radiologists blindly and independently reviewed the CXRs, documented findings, assigned radiographic assessment of lung edema (RALE) scores, and predicted the patients' COVID-19 status. We calculated interobserver reliability. The score use for diagnosis and prognosis of COVID-19 was evaluated with the area under the receiver operating characteristic curve. Results The overall RALE score failed to identify COVID-19 patients at presentation. However, the score was inversely correlated with a COVID-19 diagnosis within ≤2 days, and a positive correlation was found six days after symptom onset.Interobserver agreement with regard to separating normal from abnormal CXRs was moderate (k = 0.408) with low specificity (25% and 27%). Definite pleural effusion had almost perfect agreement (k = 0.833) and substantially reduced the odds of a COVID-19 diagnosis. Disease distribution and experts' opinion on COVID-19 status had only fair interobserver agreement. The RALE score interobserver reliability was moderate to good (intraclass correlation coefficient = 0.745). A high RALE score predicted a poor outcome (intensive care unit hospitalization, intubation, or death) in COVID-19 patients; a score of ≥5 substantially increased the odds of having a poor outcome. Conclusion Chest radiography was found not to be a valid diagnostic tool for COVID-19, as normal or near-normal CXRs are more likely early in the disease course. Pleural effusions at presentation suggest a diagnosis other than COVID-19. More extensive lung opacities at presentation are associated with poor outcome in COVID-19 patients. Thus, patients with more than minimal opacities should be monitored closely for clinical deterioration. This clinical application of CXR is its greatest strength in COVID-19 as it impacts patient care. |
| Databáze: | OpenAIRE |
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