Modified Brixia chest X‐ray severity scoring system and correlation with intubation, non‐invasive ventilation and death in a hospitalised COVID‐19 cohort

Abstract

Introduction: There are few existing severity scoring systems in the literature, and no formally widely accepted chest X-ray template for reporting COVID-19 infection. We aimed to modify the chest X-ray COVID-19 severity scoring system from the Brixia scoring system with placement of more emphasis on consolidation and to assess if the scoring tool could help predict intubation. Methods: A severity chest X-ray scoring system was modified from the Brixia scoring system. PCR positive COVID-19 positive patient's chest X-rays admitted to our hospital over 3 months were reviewed and correlated with; noninvasive ventilation, intubation and death. An analysis was performed using a receiver operating curve to predict intubation from all admission chest X-rays. Results: The median score of all 325 admission chest X-rays was 3 (Interquartile range (IQR) 0-6.5). The median score of admission chest X-rays of those who did not require ICU admission and survived was 1.5 (IQR 0-5); and 9 (IQR 4.75-12) was median admission score of those requiring intubation. The median scores of the pre-intubation ICU chest X-rays was 11.5 (IQR 9-14.125), this increased from a median admission chest X-ray score for this group of 9 (P-value < 0.01). A cut-off score of 6 had a sensitivity of 77% and specificity of 73% in predicting the need for intubation. Conclusion: Higher chest X-ray severity scores are associated with intubation, need for non-invasive ventilation and death. This tool may also be helpful in predicting intubation.

Role of chest radiograph in predicting the need for ventilator support in COVID‐19 patients

“…This difference was statistically significant (p<0.01). Hanley et al [7] in their study, reported a median score of 11.5 for pre-intubation CXR in an ICU group with a median score of 9 at the time of admission. Toussie et al [3] reported that a CXR severity score ≥3 independently predicted intubation with a p -value of 0.002.…”

“…Hanley et al [7] in their study, also stated that out of 325 patients, non-invasive ventilation was required in 9%, intubation and ICU admission were required in 14% during admission, and 69% were discharged without intubation.…”

“…Most of the patients with high CXR severity scores were >50 years of age. In a study by Hanley et al, [7] out of 325 hospitalised and COVID-19-positive patients, 63% were male, with 65 years as the mean age of the study group. In another study by Toussie et al, [3] out of 338 COVID-19-positive patients, 62% were male, with a median age of 39 years.…”

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

“…Maroldi [ 39 ] also correlated the increased Brixia H score (the largest and worst lung involvement) with the increased probability of negative outcomes and death of patients, which also makes sense. Henley [ 40 ] and Palsencia-Martinez [ 41 ] also correlated the highest Brixia scores in a modified version and second Brixia score, respectively, with the probability of later need for ventilation or intubation in COVID-19 patients. However, they did not study the clinical state of the patient together with the Brixia scores, nor did they compare alpha with delta patients as we did.…”

“…However, they did not study the clinical state of the patient together with the Brixia scores, nor did they compare alpha with delta patients as we did. Henley [ 40 ] also reported a mean Brixia score upon admittance to the ICU of 9, and the need for ventilation starting with an 11.5 Brixia score. We reported a median Brixia score of 11.3 upon admittance to the ICU in the spring patients, and 8 in the autumn patients, showing that admittance to the ICU was very late in the spring patients, who stayed home as long as they could.…”