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

Abstract


 
 
 
 Background. COVID‐19 disease, a pandemic for more than two years, has major morbidity and mortality related to pulmonary involvement. Chest radiography is the main imaging tool for critically-ill patients. As the availability of arterial blood gas analysis is limited in the Level I and II healthcare centres, major partners in providing healthcare in resource‐limited times, we planned the present study.
 Objective. To assess the role of chest radiography in predicting the need for oxygen/ventilator support in critically ill COVID‐19 patients. Methods. This hospital‐based, retrospective study included 135 patients who needed oxygen/ventilator support and had optimal‐quality chest radiographs at admission. All the chest X‐rays were evaluated and a severity score was calculated on a predesigned pro forma. Statistical evaluation of the data obtained was done using appropriate tools and methods.
 Results. Males outnumbered females, with a mean age of 54.35 ± 14.49 years. More than 72% of patients included in our study needed ventilator support while the rest needed oxygen support. There was a significant statistical correlation between the chest radiograph severity score and SPO2/PaO2 levels in our study. Using a cut‐off value >8 for the chest radiograph severity score in predicting the need for ventilator support in a Covid‐19 patient, the sensitivity, specificity and accuracy was 85.7%, 92.5% and 89.5%, respectively. Conclusions. Chest radiography remains the mainstay of imaging in critically ill COVID‐19 patients when they are on multiple life‐support systems. Though arterial blood gas analysis is the gold standard tool for assessing the need for oxygen/ventilator support in these patients, the severity score obtained from the initial chest radiograph at the time of admission may also be used as a screening tool. Chest radiography may predict the need for oxygen/ventilator support, allowing time for patients to be moved to an appropriate‐level healthcare centre, thus limiting morbidity and mortality.
 
 
 

Differential Radiographic Chest Findings in COVID-19 Positive Patients with and Without Comorbidities

“…A simple fractional zone score (SFZS) on CXR used in our study is easy to understand and apply and has been demonstrated to be clinically useful Gaurav et al . [ 13 ] We demonstrated higher SFZS on CXR at the time of presentation in Covid-19 patients with one or more comorbidities similar to Singh et al ., also predicting the course of the disease and long-term consequences. [ 12 13 14 15 ] Like any other study, the involvement of bilateral lower zones was the commonest in our study also.…”

“…[ 13 ] We demonstrated higher SFZS on CXR at the time of presentation in Covid-19 patients with one or more comorbidities similar to Singh et al ., also predicting the course of the disease and long-term consequences. [ 12 13 14 15 ] Like any other study, the involvement of bilateral lower zones was the commonest in our study also. [ 3 16 ]…”

Lung Ultrasound Score in COVID-19 Patients Correlates with PO2/FiO2, Intubation Rates, and Mortality

“…[64][65][66][67][68] Lichter 49 found that higher LUS score predicted intubation and mortality independent of CXR findings. Patients with a higher percentage of lung involvement on CXR were found to have higher intubation rates 69,70,71,72 as well as higher mortality. 69,73 Spogis 74 found that changes in CXR appeared more sensitive for predicting ICU treatment than LUS; however, LUS was more specific.…”

Still a role for the chest radiograph – humble but helpful!

“…In this issue of AJTCCM , Patnayak et al [1] describe the utility of the chest radiograph in a retrospective hospital-based study to predict the severity of COVID-19 disease. They demonstrated a significant correlation between the chest radiograph on admission and oxygenation based on a predesigned proforma severity scoring system, as well as predicting the need for ventilatory support.…”

“…He received the first Nobel Prize for Physics in 1901 for his revolutionary discovery, which heralded the age of modern physics and revolutionised diagnostic medicine. X-rays are currently an indispensable part of any hospital establishment, and the chest X-ray or chest radiograph remains the most commonly performed type of imaging.In this issue of AJTCCM, Patnayak et al [1] describe the utility of the chest radiograph in a retrospective hospital-based study to predict the severity of COVID-19 disease. They demonstrated a significant correlation between the chest radiograph on admission and oxygenation based on a predesigned proforma severity scoring system, as well as predicting the need for ventilatory support.…”