Background. COVID‐19 disease, a pandemic for more than two years, has major morbidity and mortality related to pulmonary involvement. Chest radiography is the main imaging tool for critically-ill patients. As the availability of arterial blood gas analysis is limited in the Level I and II healthcare centres, major partners in providing healthcare in resource‐limited times, we planned the present study. Objective. To assess the role of chest radiography in predicting the need for oxygen/ventilator support in critically ill COVID‐19 patients. Methods. This hospital‐based, retrospective study included 135 patients who needed oxygen/ventilator support and had optimal‐quality chest radiographs at admission. All the chest X‐rays were evaluated and a severity score was calculated on a predesigned pro forma. Statistical evaluation of the data obtained was done using appropriate tools and methods. Results. Males outnumbered females, with a mean age of 54.35 ± 14.49 years. More than 72% of patients included in our study needed ventilator support while the rest needed oxygen support. There was a significant statistical correlation between the chest radiograph severity score and SPO2/PaO2 levels in our study. Using a cut‐off value >8 for the chest radiograph severity score in predicting the need for ventilator support in a Covid‐19 patient, the sensitivity, specificity and accuracy was 85.7%, 92.5% and 89.5%, respectively. Conclusions. Chest radiography remains the mainstay of imaging in critically ill COVID‐19 patients when they are on multiple life‐support systems. Though arterial blood gas analysis is the gold standard tool for assessing the need for oxygen/ventilator support in these patients, the severity score obtained from the initial chest radiograph at the time of admission may also be used as a screening tool. Chest radiography may predict the need for oxygen/ventilator support, allowing time for patients to be moved to an appropriate‐level healthcare centre, thus limiting morbidity and mortality.

Background: The pandemic of Covid-19 resulted in significant morbidity and mortality, especially in those with pre-existing diseases like diabetes mellitus, cardiovascular diseases, etc., primarily due to extensive pulmonary involvement. The chest radiograph is the first imaging tool used in all Covid-19 patients. Hence, in this study, we attempt to understand and evaluate the role of the chest radiograph in Covid-19 patients with and without coexisting diseases. Materials and Methods: Our study included RTPCR-positive Covid-19 patients with comorbidities (560 cases) and without comorbidities (145 controls), viz. diabetes mellitus, hypertension, coronary artery disease, or thyroid disease. All controls and cases had chest radiographs with simple fractional zonal scores in a predesigned proforma. Statistical evaluation of chest radiograph scores was compared with and within groups. Results: Among the controls, approximately 63.5% revealed pulmonary findings on chest radiographs contrary to 77% among cases. No statistical differences were noted among controls and cases based on age and gender. The presence of pleural effusion was noted as a significant factor affecting the score and hence the prognosis in both controls and cases. Statistically significant differences were noted in SFZ scores between controls and various case groups. Conclusion: Chest radiograph scores in Covid-19 disease are higher in patients with comorbidities at the time of presentation, most marked in those with both hypertension and thyroid disease followed by those with hypertension and coronary artery disease. Lower zone predominance is seen in all patients including those with and without comorbidities. The chest radiograph scores become statistically significant with more than one existing comorbidity.