Chest X-ray Can Predict Outcomes for Patients With COVID-19

April 17, 2021
Whitney J. Palmer

In high pre-test probability and quick RT-PCR settings, chest X-ray scoring can be predictive.

Chest X-ray can prospectively predict outcomes for a patient with COVID-19 in high pre-test probability settings or a quick turnaround of RT-PCR testing.

In a poster presented during the 2021 ARRS Virtual Annual Meeting, Russel Reeves, M.D., a radiology resident at Thomas Jefferson University in Philadelphia, described how this type of imaging can potentially help providers prepare for the type of care a patient will need.

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“We developed an accurate and reliable tool for classifying COVID-19 severity, which can be used both at the attending chest radiologist and junior resident level,” he said. “This study identifies the laboratory, clinical and radiographic data that predict important patient outcomes, such as death, intubation, and the need for chronic renal replacement therapy (CRRT).”

For their study, Reeves’ team identified 240 patients admitted to an urban multi-center health system between March 16, 2020, and April 13, 2020, who had RT-PCR-confirmed COVID-19, including 142 males and 98 females with an average age of 65.

Chest X-rays captured at the time of admission were evaluated by three cardiothoracic radiologists and three diagnostic radiology residents who scored the images based on extent and severity of COVID-19 pneumonia. In addition, they also collected information on demographics, clinical characteristics, as well as admission laboratory values and assessed the inter-rater reliability among attending providers, residents, and the combined group of readers.

Based on their analysis, inter-rater reliability for chest X-ray scoring was high among the attending, residents, and combination group (a 0.686 average). Their evaluation showed no difference in outcomes for gender, race, ethnicity, or among those who had lung cancer or chronic obstructive pulmonary disease histories.

The team did note that even though disease severity seen on chest X-ray was an independent predictor of death, it was a non-independent predictor of CRRT and intubation – but not extracorporeal membrane oxygenation.

These results, the team said, add to the existing knowledge base around the role chest X-ray can play in COVID-19 care.

“These findings are supported by prior work, validating the utility of [chest X-ray] for patient prognostication, while adding new insight into COVID-19 infection during the initial presentation,” they said.

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