Feasibility, Reproducibility, and Clinical Validity of a Quantitative Chest X-Ray Assessment for COVID-19

Abstract

Chest X-ray (CXR) is an essential first-line tool in COVID-19 pneumonia diagnosis and management. Our study aimed at assessing 1) CXR manifestations, frequency, and distribution; 2) the feasibility and repeatability of a CXR severity score; and 3) the correlation between the CXR severity score and clinical and laboratory parameters. We reviewed baseline CXRs and clinical data of consecutive patients who presented to our emergency department and resulted positive at SARS-CoV-2 reverse transcriptase-PCR oropharyngeal swab test from March 1, 2020 to April 6, 2020. Lung abnormalities and their distribution were analyzed. A score of CXR severity was assigned by two radiologists, independently, according to the extent of lung involvement, with a maximum score of 8 for CXR. Correlations between the CXR score and the clinical data were assessed. One hundred fifty-five patients were included; 143/155 (92%) were positive at baseline CXR. Ground-glass opacity was the most common finding (141/143, 99%). Involvement was mainly bilateral (96/143, 67%), with peripheral distribution (79/143, 55%). The mean CXR severity score was 3.3 (±2); interobserver agreement was excellent, with a Cohen's K correlation coefficient of 0.901. The CXR score showed a significant positive correlation with C-reactive protein, lactate dehydrogenase, and fever duration, and a negative correlation with oxygen saturation. Chest X-ray findings are in line with those reported by computed tomography studies. The use of a visual CXR score, easy to assess and highly reproducible, can reflect the clinical severity and help the patients' management.

Performance of a Severity Score on Admission Chest Radiograph in Predicting Clinical Outcomes in Hospitalized Patients with Coronavirus Disease (COVID-19)

“…presentation (3,(8)(9)(10)(11)(12)(13). The challenges in using imaging to diagnose COVID-19 are reflected in recommendations from professional imaging societies to report CT findings in patients under investigation for possible COVID-19 using four categories (typical, indeterminate, atypical, or negative for COVID-19 pneumonia) and to give the disclaimer that the findings may overlap with other infections, drug reactions, and other causes of acute lung injury (14,15).…”

Automatic Evaluation of the Lung Condition of COVID-19 Patients Using X-ray Images and Convolutional Neural Networks

“…Wong et al [ 24 ] (2020) noted that radiographic findings do indicate positivity in COVID-19 patients, the conclusions of which are further supported by Orsi et al [ 25 ] (2020) and Cozzi et al [ 26 ] (2020). Borghesi and Maroldi [ 27 ] (2020) defined a scoring system for X-ray COVID-19 monitoring, concluding that there is a definite possibility of determining the severity of the disease through the observation of X-ray images.…”

COVID-19 pneumonia—ultrasound, radiographic, and computed tomography findings: a comprehensive pictorial essay

“…Chest radiography’s main advantages are the wide availability, fast execution, low cost, and acquisition at the patient’s bed [ 14 ].…”

“…Chest X-ray severity score, based on the extension of lung abnormalities, has been proposed by some studies [ 12 , 14 , 16 ] and proved to be an independent predictor of the patient’s outcome [ 12 , 14 ].…”