Early clinical predictors of severe acute respiratory syndrome in the emergency department

ABSTRACT Objectives: To assess the association of diagnostic predictors available in the emergency department (ED) with the outcome diagnosis of severe acute respiratory syndrome (SARS). Methods: This retrospective cohort study describes all patients from the Amoy Garden complex who presented to an ED SARS screening clinic during a 2-month outbreak. Clinical and diagnostic predictors were recorded, along with ED diagnoses. Final diagnoses were established independently based on diagnostic tests performed after the ED visit. Associations of key predictors with the final diagnosis of SARS were described. Results: Of 821 patients, 205 had confirmed SARS, 35 undetermined SARS and 581 non-SARS. Multivariable logistic regression showed that the strongest predictors of SARS were abnormal chest x-ray (odds ratio [OR] = 17.4), subjective fever (OR = 9.7), temperature >38°C (OR = 6.4), myalgias (OR = 5.5), chills and rigors (OR = 4.0) and contact exposure (OR = 2.6). In a subset of 176 patients who had a complete blood cell count performed, the strongest predictors were temperature ≥38ºC (OR = 15.5), lymphocyte count <1000 (OR = 9.3) and abnormal chest x-ray (OR = 5.7). Diarrhea was a powerful negative predictor (OR = 0.03) of SARS. Conclusions: Two components of the World Health Organization case definition — fever and contact exposure — are helpful for ED decision-making, but respiratory symptoms do not discriminate well between SARS and non-SARS. Emergency physicians should consider the presence of diarrhea, chest x-ray findings, the absolute lymphocyte count and the platelet count as significant modifiers of disease likelihood. Prospective validation of these findings in other clinical settings is desirable.

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Development of Severity and Mortality Prediction Models for COVID-19 Patients at Emergency Department Including the Chest X-Ray

10.21203/rs.3.rs-88282/v1 ◽

2020 ◽

Author(s):

Pilar Calvillo Batllés ◽

Leonor Cerdá-Alberich ◽

Carles Fonfría-Esparcia ◽

Ainhoa Carreres-Ortega ◽

Carlos Francisco Muñoz-Núñez ◽

...

Keyword(s):

Emergency Department ◽

Intensive Care ◽

Lymphocyte Count ◽

Prediction Models ◽

Mortality Prediction ◽

X Ray ◽

Extent Score ◽

Mortality Prediction Models ◽

Chest X Ray ◽

D Dimer

Abstract Objectives: To develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters. Methods: All symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for model selection.Results: A total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC=0.94 and AUC-PRC=0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC=0.97 and AUC-PRC=0.78. The addition of CXR CNN-based indices slightly improved the predictive metrics for mortality (AUC-ROC=0.97 and AUC-PRC=0.83).Conclusion: The developed and internally validated severity and mortality prediction models could be useful as triage tools for COVID-19 patients and they should be further validated at different ED.

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156. Correlation Between WHO (World Health Organization) Case Definition of Severe Pneumonia and Lung POCUS (Point of Care Ultrasound) vs Chest X-ray (CXR) Findings to Diagnose Pediatric Community-Acquired Pneumonia (CAP) in Limited Resource Settings

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.156 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S94-S95

Author(s):

Ingrid Y Camelo ◽

Rachel Pieciak ◽

Ilse castro-aragon ◽

Bindu Setty ◽

Lauren Etter ◽

...

Keyword(s):

Low Income ◽

Point Of Care ◽

Severe Pneumonia ◽

Limited Resource ◽

Case Definition ◽

World Health ◽

Point Of Care Ultrasound ◽

X Ray ◽

Chest X Ray ◽

Definition Of

Abstract Background Childhood pneumonia is one of the leading causes of death in low-income countries. The diagnosis of pediatric pneumonia is a critical epidemiological duty for treatment effectiveness and vaccine surveillance. Previous studies have demonstrated an important lack in correlation between CXR findings and the clinical WHO case definition of severe pneumonia. Lung Point of Care Ultrasound (POCUS) has demonstrated in multiple studies to be more sensitive and specific for diagnosing pneumonia in the pediatric population. With no exposure to radiation, extensive availability in limited-resource settings, and easy interpretation, this modality can be a breakpoint in making a more accurate correlation between pneumonia clinical findings and diagnostic imaging. Methods 50 children from 1-59 months meeting the WHO case definition of severe pneumonia were enrolled at the Emergency Department at University Teaching Hospital (UTH) in Lusaka, Zambia. Children underwent lung POCUS and CXR. Correlation between symptoms and all abnormalities (consolidation, effusion, and interstitial patterns) seen in both imaging modalities were analyzed by calculating the proportion of children with abnormalities on CXR and ultrasound. Each participant was assigned a score based on findings. 0 = normal, 1 = consolidation only, 2 = Consolidation and non-consolidation (interstitial and/or effusion) and 3 = non-consolidation (interstitial and/or effusion) only. Results 44 (90%) of children had abnormalities on CXR and 46 (94%) on POCUS. Five children (10%) had normal findings on CXR vs 3 (6%) on Lung POCUS. 4 (8%) had consolidation only on CXR vs 0 (0%) on POCUS. 19 (39%) had consolidation and non-consolidation (interstitial and/or effusion) on CXR vs. 20 (41%) on POCUS. 21 (43%) had non-consolidation (interstitial and/or effusion) only on CXR vs. 26 (53%) on POCUS. Figure 1. Scores Asigned Based on Imaging Findings for CXR and Lung POCUS Figure 2. Chest X Ray Anterior Posterior (AP) view showing Bilareral Interstitial Pattern Figure 3. Lung POCUS (Point of Care Ultrasound) findings of bilateral Consolidation and non-consolidation pattern and bilateral interstitial pattern (only finding on CXR) Conclusion More children with clinical pneumonia had normal findings on CXR than on POCUS. POCUS was a better imaging technique to show consolidation and non-consolidation patterns than CXR. The higher proportion of children diagnosed with consolidation and non-consolidation patterns on POCUS suggest that CXR might not be the ideal gold standard to diagnose pneumonia in children. Disclosures All Authors: No reported disclosures

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Correction to: Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study

European Radiology Experimental ◽

10.1186/s41747-021-00215-3 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Cristian Giuseppe Monaco ◽

Federico Zaottini ◽

Simone Schiaffino ◽

Alessandro Villa ◽

Gianmarco Della Pepa ◽

...

Keyword(s):

Emergency Department ◽

Severity Score ◽

X Ray ◽

Emergency Department Admission ◽

Centre Study ◽

Chest X Ray

An amendment to this paper has been published and can be accessed via the original article.

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Ground-glass opacity on Emergency Department chest X-ray: a risk factor for in-hospital mortality and organ failure in elderly admitted for COVID-19

Postgraduate Medicine ◽

10.1080/00325481.2021.2021741 ◽

2021 ◽

Author(s):

Noel Roig-Marín ◽

Pablo Roig-Rico

Keyword(s):

Emergency Department ◽

Risk Factor ◽

Hospital Mortality ◽

Organ Failure ◽

Ground Glass Opacity ◽

Ground Glass ◽

X Ray ◽

Chest X Ray

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Analysis of Separability of COVID-19 and Pneumonia in Chest X-ray Images by Means of Convolutional Neural Networks

Proceedings ◽

10.3390/proceedings2020054031 ◽

2020 ◽

Vol 54 (1) ◽

pp. 31

Author(s):

Joaquim de Moura ◽

Lucía Ramos ◽

Plácido L. Vidal ◽

Jorge Novo ◽

Marcos Ortega

Keyword(s):

Neural Networks ◽

Convolutional Neural Networks ◽

Clinical Symptoms ◽

Early Stage ◽

World Health ◽

Complete Analysis ◽

Screening Process ◽

X Ray ◽

Chest X Ray ◽

Health Organization

The new coronavirus (COVID-19) is a disease that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On 11 March 2020, the coronavirus outbreak has been labelled a global pandemic by the World Health Organization. In this context, chest X-ray imaging has become a remarkably powerful tool for the identification of patients with COVID-19 infections at an early stage when clinical symptoms may be unspecific or sparse. In this work, we propose a complete analysis of separability of COVID-19 and pneumonia in chest X-ray images by means of Convolutional Neural Networks. Satisfactory results were obtained that demonstrated the suitability of the proposed system, improving the efficiency of the medical screening process in the healthcare systems.

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Abnormal chest X-ray in a patient with carcinoma of the cervix.

Postgraduate Medical Journal ◽

10.1136/pgmj.73.864.671 ◽

1997 ◽

Vol 73 (864) ◽

pp. 671-673

Author(s):

P. Aggarwal ◽

R. Handa ◽

J. P. Wali ◽

N. Wig ◽

A. Kumar

Keyword(s):

X Ray ◽

Abnormal Chest ◽

Chest X Ray

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Portable Ventilation/Perfusion Scanning is Useful for Evaluating Clinically Significant Pulmonary Embolism in the ICU Despite Abnormal Chest Radiography

Journal of Intensive Care Medicine ◽

10.1177/0885066618807859 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1032-1038 ◽

Cited By ~ 1

Author(s):

Aaron S. Weinberg ◽

William Chang ◽

Grace Ih ◽

Alan Waxman ◽

Victor F. Tapson

Keyword(s):

Pulmonary Embolism ◽

Chest Radiograph ◽

High Probability ◽

Hemodynamic Instability ◽

X Rays ◽

X Ray ◽

Abnormal Chest ◽

Chest X Ray ◽

Low Probability ◽

Clinically Significant

Objective: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU. Design: Two physicians conducted chart reviews and original V/Q reports. A staff radiologist, with 40 years of experience, rated chest x-ray abnormalities using predetermined criteria. Setting: The study was conducted in the ICU. Patients: The first 100 consecutive patients with suspected PE who underwent a portable V/Q scan. Interventions: Those with a portable V/Q scan. Results: A normal baseline chest radiograph was found in only 6% of patients. Fifty-three percent had moderate, 24% had severe, and 10% had very-severe radiographic abnormalities. Despite the abnormal x-rays, 88% of the V/Q scans were low probability for a PE despite an average abnormal radiograph rating of moderate. A high-probability V/Q for PE was diagnosed in 3% of the population despite chest x-ray ratings of moderate to severe. Six patients had their empiric anticoagulation discontinued after obtaining the results of the V/Q scan, and no anticoagulation was started for PE after a low-probability V/Q scan. Conclusion: Despite the large percentage of moderate-to-severe x-ray abnormalities, PE can still be diagnosed (high-probability scan) in the ICU with a portable V/Q scan. Although low-probability scans do not rule out acute PE, it appeared less likely that any patient with a low-probability V/Q scan had severe hypoxemia or hemodynamic instability due to a significant PE, which was useful to clinicians and allowed them to either stop or not start anticoagulation.

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The Hanging Chin Sign As A Mortality Predictor In Geriatric Patients At The Emergency Department: A Retrospective Cohort Study

10.21203/rs.3.rs-496256/v1 ◽

2021 ◽

Author(s):

Anneloes NJ Huijgens ◽

Laurens J van Baardewijk ◽

Carolina JPW Keijsers

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Geriatric Patients ◽

Lateral View ◽

X Ray ◽

Hospital Patients ◽

Chest X Ray

Abstract BACKGROUND: At the emergency department, there is a need for an instrument which is quick and easy to use to identify geriatric patients with the highest risk of mortality. The so- called ‘hanging chin sign’, meaning that the mandibula is seen to project over one or more ribs on the chest X-ray, could be such an instrument. This study aims to investigate whether the hanging chin sign is a predictor of mortality in geriatric patients admitted through the emergency department. METHODS: We performed an observational retrospective cohort study in a Dutch teaching hospital. Patients of ≥ 65 years who were admitted to the geriatric ward following an emergency department visit were included. The primary outcome of this study was mortality. Secondary outcomes included the length of admission, discharge destination and the reliability compared to patient-related variables and the APOP screener.RESULTS: 396 patients were included in the analysis. Mean follow up was 300 days; 207 patients (52%) died during follow up. The hanging chin sign was present in 85 patients (21%). Patients with the hanging chin sign have a significantly higher mortality risk during admission (OR 2.94 (1.61 to 5.39), p < 0.001), within 30 days (OR 2.49 (1.44 to 4.31), p = 0.001), within 90 days (OR 2.16 (1.31 to 3.56), p = 0.002) and within end of follow up (OR 2.87 (1.70 to 4.84),p < 0.001). A chest X-ray without a PA view or lateral view was also associated with mortality. This technical detail of the chest x-ray and the hanging chin sign both showed a stronger association with mortality than patient-related variables or the APOP screener. CONCLUSIONS: The hanging chin sign and other details of the chest x-ray were strong predictors of mortality in geriatric patients presenting at the emergency department. Compared to other known predictors, they seem to do even better in predicting mortality.

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