It’s not over until it’s over: the chameleonic behavior of COVID-19 over a six-day period

Fichera, Giulia; Stramare, Roberto; Conti, Giorgio; Motta, Raffaella; Giraudo, Chiara

doi:10.1007/s11547-020-01203-0

Cited by 30 publications

(26 citation statements)

References 9 publications

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“…The role of CXR in clinical monitoring of this patients, especially in ICU, is still debated: Fleischner Society do not recommend daily CXR in stable intubated patients, but it is also true that the disease can progress very quickly [16,17]. Our opinion is that radiological imaging should be always associated with clinical and laboratoristic parameters when monitoring the disease course, waiting for readily effective therapies.…”

Section: Discussionmentioning

confidence: 99%

Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome

et al. 2020

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Aim The purpose of this study is to describe the main chest radiological features (CXR) of COVID-19 and correlate them with clinical outcome. Materials and methods This is a retrospective study involving patients with clinical-epidemiological suspect of COVID-19 infection, who performed CXRs at the emergency department (ED) of our University Hospital from March 1 to March 31, 2020. All patients performed RT-PCR nasopharyngeal and throat swab, CXR at the ED and clinical-epidemiological data. RT-PCR results were considered the reference standard. The final outcome was expressed as discharged or hospitalized patients into a medicine department or intensive care unit (ICU). Results Patients that had a RT-PCR positive for COVID-19 infection were 234 in total: 153 males (65.4%) and 81 females (34.6%), with a mean age of 66.04 years (range 18-97 years). Thirteen CXRs were negative for radiological thoracic involvement (5.6%). The following alterations were more commonly observed: 135 patients with lung consolidations (57.7%), 147 (62.8%) with GGO, 55 (23.5%) with nodules and 156 (66.6%) with reticular-nodular opacities. Patients with consolidations and GGO coexistent in the same radiography were 35.5% of total. Peripheral (57.7%) and lower zone distribution (58.5%) were the most common predominance. Moreover, bilateral involvement (69.2%) was most frequent than unilateral one. Baseline CXR sensitivity in our experience is about 67.1%. The most affected patients were especially males in the age group 60-79 years old (45.95%, of which 71.57% males). RALE score was slightly higher in male than in female patients. ANOVA with Games-Howell post hoc showed significant differences of RALE scores for group 1 vs 3 (p < 0.001) and 2 vs 3 (p = 0.001). Inter-reader agreement in assigning RALE score was very good (ICC: 0.92-with 95% confidence interval 0.88-0.95). Conclusion In COVID-19, CXR shows patchy or diffuse reticular-nodular opacities and consolidation, with basal, peripheral and bilateral predominance. In our experience, baseline CXR had a sensitivity of 68.1%. The RALE score can be used in the emergency setting as a quantitative method of the extent of SARS-CoV-2 pneumonia, correlating with an increased risk of ICU admission.

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Section: Discussionmentioning

confidence: 99%

Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome

et al. 2020

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“…In fact, radiographs guarantee an adequate evaluation of the infection simultaneously optimising organisational, safety and radiation exposure issues. Regarding COVID-19, for instance, FICHERA et al [4] showed the necessity of a long-term monitoring of COVID-19 patients in intensive care unit (ICU) despite the prompt amelioration that usually occurs after intubation. Moreover, to further contribute to the management of COVID-19 patients, chest radiography-based scores, partially recalling scores proposed for previous Coronavirus epidemics such as SARS and MERS, have been proposed [8,[11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Validation of a composed COVID-19 chest radiography score: the CARE project

et al. 2020

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ObjectivesThe aim of this study was to validate a composed coronavirus disease 2019 (COVID-19) chest radiography score (CARE) based on the extension of ground-glass opacity (GG) and consolidations (Co), separately assessed, and to investigate its prognostic performance.MethodsCOVID-19-positive patients referring to our tertiary centre during the first month of the outbreak in our area and with a known outcome were retrospectively evaluated. Each lung was subdivided into three areas and a three-grade score assessing the extension of GG and Co was used. The CARE was derived from the sum of the subscores. A mixed-model ANOVA with post hoc Bonferroni correction was used to evaluate whether differences related to the referring unit (emergency room, COVID-19 wards and intensive care unit (ICU)) occurred. Logistic regression analyses were used to investigate the impact of CARE, patients’ age and sex on the outcome. To evaluate the prognostic performance of CARE, receiver operating characteristic curves were computed for the entire stay and at admission only.ResultsA total of 1203 chest radiographs of 175 patients (120 males; mean age 67.81±15.5 years old) were examined. On average, each patient underwent 6.8±10.3 radiographs. Patients in ICU as well as deceased patients showed higher CARE scores (p<0.05, each). Age, Co and CARE significantly influenced the outcome (p<0.05 each). The CARE demonstrated good accuracy (area under the curve (AUC)=0.736) using longitudinal data as well as at admission only (AUC=0.740). A CARE score of 17.5 during hospitalisation showed 75% sensitivity and 69.9% specificity.ConclusionsThe CARE was demonstrated to be a reliable tool to assess the severity of pulmonary involvement at chest radiography with a good prognostic performance.

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“…Radiological facilities are among the primary units requiring dedicated management, since radiological imaging can contribute to the diagnosis and monitoring of the disease [ 8 , 9 , 10 , 11 , 12 ]. Chest radiographs and thoracic ultrasound US are easily accessible tools available at the bedside of COVID-19 patients; nevertheless, Computed Tomography (CT) imaging may be also necessary to investigate pulmonary embolism, comorbidities, and/or to carefully evaluate the response to specific treatments [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of a Modified Organizational Model to Guarantee CT Workflow during the COVID-19 Outbreak in the Tertiary Hospital of Padova, Italy

Cester

Giraudo

Causin

et al. 2020

JCM

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At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) outbreak in Italy, the cluster of Vò Euganeo was managed by the University Hospital of Padova. The Department of Diagnostic Imaging (DDI) conceived an organizational approach based on three different pathways for low-risk, high-risk, and confirmed Coronavirus Disease 19 (COVID-19) patients to accomplish three main targets: guarantee a safe pathway for non-COVID-19 patients, ensure health personnel safety, and maintain an efficient workload. Thus, an additional pathway was created with the aid of a trailer-mounted Computed Tomography (CT) scanner devoted to positive patients. We evaluated the performance of our approach from February 21 through April 12 in terms of workload (e.g., number of CT examinations) and safety (COVID-19-positive healthcare workers). There was an average of 72.2 and 17.8 COVID-19 patients per day in wards and the Intensive Care Unit (ICU), respectively. A total of 176 high-risk and positive patients were examined. High Resolution Computed Tomography (HRCT) was one of the most common exams, and 24 pulmonary embolism scans were performed. No in-hospital transmission occurred in the DDI neither among patients nor among health personnel. The weekly number of in-patient CT examinations decreased by 27.4%, and the surgical procedures decreased by 29.5%. Patient screening and dedicated diagnostic pathways allowed the maintenance of high standards of care while working in safety.

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It’s not over until it’s over: the chameleonic behavior of COVID-19 over a six-day period

Cited by 30 publications

References 9 publications

Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome

Chest X-ray in new Coronavirus Disease 2019 (COVID-19) infection: findings and correlation with clinical outcome

Validation of a composed COVID-19 chest radiography score: the CARE project

Retrospective Analysis of a Modified Organizational Model to Guarantee CT Workflow during the COVID-19 Outbreak in the Tertiary Hospital of Padova, Italy

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