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

Abo-Hedibah, Sherif A.; Tharwat, Nehal; Elmokadem, Ali H.

doi:10.5114/pjr.2021.108172

Cited by 17 publications

(15 citation statements)

References 26 publications

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“…Our results were concordant with prior studies that reported inter-observer reliability of the severity scoring systems. The inter-reader agreement for CT-SS was excellent in two different studies (ICC median = 0.925, ICC mean = 0.936 and K = 0.85, p = 0.001) [ 10 , 27 ]. Li et al reported excellent inter-observer consistency of the CT visual quantitative analysis with ICC 0.976 (95% CI 0.962–0.985) between 2 observers using only the TSS [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of chest CT severity scoring systems for COVID-19

et al. 2022

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Purpose To compare the diagnostic performance and inter-observer agreement of five different CT chest severity scoring systems for COVID-19 to find the most precise one with the least interpretation time. Methods and materials This retrospective study included 85 patients (54 male and 31 female) with PCR-confirmed COVID-19. They underwent CT to assess the severity of pulmonary involvement. Three readers were asked to assess the pulmonary abnormalities and score the severity using five different systems, including chest CT severity score (CT-SS), chest CT score, total severity score (TSS), modified total severity score (m-TSS), and 3-level chest CT severity score. Time consumption on reporting of each system was calculated. Results Two hundred fifty-five observations were reported for each system. There was a statistically significant inter-observer agreement in assessing qualitative lung involvement using the m-TSS and the other four quantitative systems. The ROC curves revealed excellent and very good diagnostic accuracy for all systems when cutoff values for detection severe cases were > 22, > 17, > 12, and > 26 for CT-SS, chest CT score, TSS, and 3-level CT severity score. The AUC was very good (0.86), excellent (0.90), very good (0.89), and very good (0.86), respectively. Chest CT score showed the highest specificity (95.2%) in discrimination of severe cases. Time consumption on reporting was significantly different (< 0.001): CT-SS > 3L-CT-SS > chest CT score > TSS. Conclusion All chest CT severity scoring systems in this study demonstrated excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. CT-SS and TSS had the highest specificity and least time for interpretation. Key Points • All chest CT severity scoring systems discussed in this study revealed excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. • Chest CT scoring system and TSS had the highest specificity. • Both TSS and m-TSS consumed the least time compared to the other three scoring systems. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08432-5.

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Section: Discussionmentioning

confidence: 99%

Comparison of chest CT severity scoring systems for COVID-19

et al. 2022

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“…Conventional chest X-ray proved to have an excellent sensitivity in diagnosing lung involvement in moderate-to-severe COVID-19 cases [ 38 ], and the Brixia scale proved to be the best method to evaluate conventional X-ray chest images during the COVID-19 pandemics [ 10 ]. Maroldi [ 39 ] correlated the A, L and E Brixia scores with the outcomes of COVID-19 pneumonia patients, which makes sense: the lower the Brixia score, the less the lungs were affected upon admission (A score); at the end of hospitalization (E score); and, of course, at the lowest lung involvement (L score).…”

Section: Discussionmentioning

confidence: 99%

Brixia and qSOFA Scores, Coagulation Factors and Blood Values in Spring versus Autumn 2021 Infection in Pregnant Critical COVID-19 Patients: A Preliminary Study

et al. 2022

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(1) Background: From the recent variants of concern of the SARS-CoV-2 virus, in which the delta variant generated more negative outcomes than the alpha, we hypothesized that lung involvement, clinical condition deterioration and blood alterations were also more severe in autumn infection, when the delta variant dominated (compared with spring infections, when the alpha variant dominated), in severely infected pregnant patients. (2) Methods: In a prospective study, all pregnant patients admitted to the ICU of the Elena Doamna Obstetrics and Gynecology Hospital with a critical form of COVID-19 infection—spring group (n = 11) and autumn group (n = 7)—between 1 January 2021 and 1 December 2021 were included. Brixia scores were calculated for every patient: A score, upon admittance; H score, the highest score throughout hospitalization; and E score, at the end of hospitalization. For each day of Brixia A, H or E score, the qSOFA (quick sepsis-related organ failure assessment) score was calculated, and the blood values were also considered. (3) Results: Brixia E score, C-reactive protein, GGT and LDH were much higher, while neutrophil count was much lower in autumn compared with spring critical-form pregnant patients. (4) Conclusions: the autumn infection generated more dramatic alterations than the spring infection in pregnant patients with critical forms of COVID-19. Larger studies with more numerous participants are required to confirm these results.

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“…The severity of pulmonary involvement by COVID‐19 was assessed by chest CT or chest X‐ray. One reviewer with 13 years of experience in thoracic imaging (DB) assessed all chest scans using the total severity score (TSS) 14 to assess the severity in CT scans and (CXR‐SS) or Brixia severity score 15 to assess severity in chest X‐rays. It evaluates the inflammatory abnormalities in each of the five lobes of both lungs, including the presence of ground glass opacities (GGOs), consolidation, or mixed GGOs.…”

Section: Methodsmentioning

confidence: 99%

COVID‐19‐associated acute invasive fungal sinusitis: Clinical and imaging findings

Elmokadem

Bayoumi

Mansour

et al. 2022

Journal of Neuroimaging

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Background and Purpose:The purpose is to provide a comprehensive report describing the clinical and imaging features of Coronavirus disease 2019 (COVID-19)-related acute invasive fungal sinusitis (AIFS) and associated comorbidities. Methods:A retrospective study was conducted on 25 patients (12 males and 13 females, mean age of 53.9±9.1 years). All patients had positive polymerase chain reaction test for COVID-19 and histopathological proof of AIFS. Patients underwent computed tomography (CT) and magnetic resonance examinations to assess sinonasal, orbital, and cranial spread. Results:The most prevalent comorbidity among the study cohort was diabetes mellitus (DM). Twenty-one patients (84%) were diagnosed in the post-COVID-19 period after hospital discharge, with a mean interval of 19.1±9.2 days. Steroid treatment was given to 19 patients (76%). Orbital manifestations were the presenting symptoms in all patients, followed by facial edema, nasal discharge, and neurological symptoms. Sinonasal involvement ranged from mucosal thickening to complete sinus opacification by a predominant isodensity on CT, low T1, and high T2 signal intensity with variable enhancement patterns.Twenty-four patients had a unilateral orbital extension, and 12 patients showed signs of intracranial extension. Bone involvement was detected in 16 patients (64%). Follow-up scans in 18 patients (72%) showed rapid progression of the disease. Eight patients (32%) died, six from neurological complications and two from severe respiratory failure. Conclusion: Steroids, DM, and severe COVID-19 are the major risk factors of AIFS in the post-COVID-19 era. Imaging scans in all patients revealed different sinonasal, facial, orbital features, and intracranial involvement with rapid progression of the findings on follow-up scans.

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

Cited by 17 publications

References 26 publications

Comparison of chest CT severity scoring systems for COVID-19

Comparison of chest CT severity scoring systems for COVID-19

Brixia and qSOFA Scores, Coagulation Factors and Blood Values in Spring versus Autumn 2021 Infection in Pregnant Critical COVID-19 Patients: A Preliminary Study

COVID‐19‐associated acute invasive fungal sinusitis: Clinical and imaging findings

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