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

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.

Abdominal obesity phenotype is associated with COVID-19 chest X-ray severity score better than BMI-based obesity

“…The readers rated pulmonary parenchymal involvement using a semi-quantitative severity score already validated for COVID-19 pneumonia assessment [ 21 , 37 ]. First, the lungs were divided into six zones (three per lung) on frontal chest projection: the upper zone (from the lung apex to the aortic arch profile), the middle zone (lung hilum, from the aortic arch profile to the lower margin of the lower pulmonary vein), the lower zone (from the lower margin of the lower pulmonary vein to the diaphragm), Fig.…”

Is chest X-ray severity scoring for COVID-19 pneumonia reliable?

“…Recently, other scoring systems were designed specifically for patients with confirmed COVID-19. Similar to the Brixia score, Monaco et al ., [ 23 ] subdivided each lung into 3 zones and gave each zone a score on a scale from 0 to 3; however, the point assignment was based on the percentage of pulmonary involvement in each zone rather than the type of opacity. They reported moderate to excellent inter-observer agreement in the assessment of severity scores but weak correlation with clinical parameters.…”

The Relation Between D-dimer Level and Chest X-Ray (CXR) Scoring in COVID-19 Patients:

“…Every zone can be given score from the scale 0 until 3. Zero means there is no abnormality of lung's parenchyma, 1 means we can see infiltrate on this zone, score 2 is given when there is less than 50% opacity on lung's parenchyma, and score 3 is get when there is ≥ 50% opacity on lung's parenchyma or alveolar predominance [14,16]. The collecting data then be analyzed with SPSS version 25 for windows.…”