Coronavirus Disease 2019 Outbreak: Use of a Chest X-ray Scoring System and Evaluation of the Radiologic Findings

Abstract Background There is no consensus on the imaging modality to be used in the diagnosis and management of Coronavirus disease 2019 (COVID-19) pneumonia. The purpose of this study was to make a comparison between computed tomography (CT) and chest X-ray (CXR) through a scoring system that can be beneficial to the clinicians in making the triage of patients diagnosed with COVID-19 pneumonia at their initial presentation to the hospital. Results Patients with a negative CXR (30.1%) had significantly lower computed tomography score (CTS) (p < 0.001). Among the lung zones where the only infiltration pattern was ground glass opacity (GGO) on CT images, the ratio of abnormality seen on CXRs was 21.6%. The cut-off value of X-ray score (XRS) to distinguish the patients who needed intensive care at follow-up (n = 12) was 6 (AUC = 0.933, 95% CI = 0.886–0.979, 100% sensitivity, 81% specificity). Conclusions Computed tomography is more effective in the diagnosis of COVID-19 pneumonia at the initial presentation due to the ease detection of GGOs. However, a baseline CXR taken after admission to the hospital can be valuable in predicting patients to be monitored in the intensive care units.

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Which role for chest x-ray score in predicting the outcome in COVID-19 pneumonia?

European Radiology ◽

10.1007/s00330-020-07504-2 ◽

2020 ◽

Author(s):

Roberto Maroldi ◽

Paolo Rondi ◽

Giorgio Maria Agazzi ◽

Marco Ravanelli ◽

Andrea Borghesi ◽

...

Keyword(s):

Patient Outcome ◽

Scoring System ◽

Clinical Decision Making ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Lung Involvement ◽

X Ray ◽

Entire Cohort ◽

Discharged Patients ◽

Chest X Ray

Abstract Objective We aim to demonstrate that a chest X-ray (CXR) scoring system for COVID-19 patients correlates with patient outcome and has a prognostic value. Methods This retrospective study included CXRs of COVID-19 patients that reported the Brixia score, a semi-quantitative scoring system rating lung involvement from 0 to 18. The highest (H) and lowest (L) values were registered along with scores on admission (A) and end of hospitalization (E). The Brixia score was correlated with the outcome (death or discharge). Results A total of 953 patients met inclusion criteria. In total, 677/953 were discharged and 276/953 died during hospitalization. A total of 524/953 had one CXR and 429/953 had more than one CXR. H-score was significantly higher in deceased (median, 12; IQR 9–14) compared to that in discharged patients (median, 8; IQR 5–11) (p < 0.0001). In 429/953 patients with multiple CXR, A-score, L-score, and E-score were higher in deceased than in discharged patients (A-score 9 vs 8; p = 0.039; L-score 7 vs 5; p < 0.0003; E-score 12 vs 7; p < 0.0001). In the entire cohort, logistic regression showed a significant predictive value for age (p < 0.0001, OR 1.13), H-score (p < 0.0001, OR 1.25), and gender (p = 0.01, male OR 1.67). AUC was 0.863. In patients with ≥ 2 CXR, A-, L-, and E-scores correlated significantly with the outcome. Cox proportional hazards regression indicated age (p < 0.0001, HR 4.17), H-score (< 9, HR 0.36, p = 0.0012), and worsening of H-score vs A score > 3 (HR 1.57, p = 0.0227) as associated with worse outcome. Conclusions The Brixia score correlates strongly with disease severity and outcome; it may support the clinical decision-making, particularly in patients with moderate-to-severe signs and symptoms. The Brixia score should be incorporated in a prognostic model, which would be desirable, particularly in resource-constraint scenarios. Key Points • To demonstrate the importance of the Brixia score in assessing and monitoring COVID-19 lung involvement. • The Brixia score strongly correlates with patient outcome and can be easily implemented in the routine reporting of CXR.

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A chest x-ray scoring system for low birth weight babies

Clinical Radiology ◽

10.1016/s0009-9260(05)82240-8 ◽

1990 ◽

Vol 42 (5) ◽

pp. 378-379

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Scoring System ◽

X Ray ◽

Low Birth Weight Babies ◽

Chest X Ray

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Discordance Between Radiologic Findings and Molecular Testing in Patients With Underlying Hematologic Malignancy and Coronavirus Disease 2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa372 ◽

2020 ◽

Vol 7 (9) ◽

Author(s):

Mohammed Raja ◽

Yoichiro Natori ◽

Aditya Chandorkar ◽

Jose F Camargo ◽

Jacques Simkins ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Clinical Presentation ◽

Hematologic Malignancy ◽

Severe Disease ◽

Molecular Testing ◽

Radiographic Findings ◽

X Ray ◽

Radiologic Findings ◽

Immunosuppressed Patients ◽

Chest X Ray

Abstract Severe acute respiratory syndrome coronavirus 2 is associated with severe disease in patients with hematologic malignancy. We report a series of patients with underlying hematologic malignancy and coronavirus disease of 2019 with discrepancy between radiographic findings and molecular testing. Initial chest x-ray findings should raise suspicion in immunosuppressed patients with typical clinical presentation even with negative initial testing.

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Brixia Chest X-ray Scoring System in Critically Ill Patients with COVID-19 Pneumonia for Determining Outcomes

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48844.15197 ◽

2021 ◽

Author(s):

Nishant Agrawal ◽

Samruddhi Dhanaji Chougale ◽

Prashant Jedge ◽

Shivakumar Iyer ◽

John Dsouza

Keyword(s):

Scoring System ◽

Early Stage ◽

Tertiary Care ◽

Categorical Variables ◽

P Value ◽

Care Hospital ◽

X Ray ◽

Lung Abnormalities ◽

Chest X Ray ◽

The Mean

Introduction: In early stage of disease of Coronavirus Disease 2019 (COVID-19) infection chest Computed Tomography (CT) imaging is considered as the most effective method for detecting lung abnormalities. A Brixia Chest X-ray (CXR) scoring system which uses an 18-point severity scale to grade lung abnormalities due to COVID-19 was developed to improve the risk stratification for infected patients. Aim: To ascertain the validity of Brixia scoring system and to measure the outcome in COVID-19 patients. Materials and Methods: A retrospective study was conducted from 1st April 2020 to 31st July 2020, at a tertiary care hospital in India. Baseline CXR of COVID-19 patients were scored based on Brixia scoring system. The lungs were divided into six equal zones. Subsequently, scores (from 0-3) were assigned to each zone, based on lung abnormalities. A group comparison was implemented using Chi-Square test for categorical variables. Whereas an independent t-test was applied for continuous variables that followed normal distribution. Results: The study included 130 patients. The mean age was 57.09±13.73 years, 70.8% patients included were males. Out of 130 patients, 79 patients died. Among patients who died the mean CXR score was calculated to be 12.13±2.50. The mean CXR score was calculated to be 11.18±2.30 in patients who recovered and got discharged. During the process of comparison of CXR scores with the outcomes, the t-value came out to be 2.20 and the resulting p-value was 0.03 (statistically significant). Conclusion: Brixia score more than 12 was associated with increased mortality due to COVID-19, with p-value of 0.03.

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The various prognostic scoring system used for predicting COVID-19 mortality

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20213218 ◽

2021 ◽

Vol 8 (9) ◽

pp. 4611

Author(s):

Khaled Mohamed Elsharkawy ◽

Mohammed Abdulaziz Aljawi ◽

Hani Helal Alhassani ◽

Sadeen Essam Ezzat ◽

Ziad Abdulmoti Alruwaithi ◽

...

Keyword(s):

Scoring System ◽

Severe Disease ◽

Scoring Systems ◽

Medical Attention ◽

C Reactive Protein ◽

X Ray ◽

Reactive Protein ◽

X Ray Imaging ◽

Chest X Ray ◽

Prognostic Scoring Systems

The widespread pandemic of Coronavirus disease 2019 (COVID-19) has been reported to affect most countries all over the world, and burden all of the affected healthcare systems. COVID-19 has first emerged in December 2019 within the district of Wuhan which is located in China. Many prognostic scoring systems have been developed to predict severe disease and death for patients with COVID-19. In this literature review, the aim to discuss the various prognostic scoring system used for predicting COVID-19 mortality. It has mainly approached the prognostic scoring systems in two main ways: The clinical and biochemical ways. In addition, the research also investigates the chest X-ray imaging findings based on scoring systems for predicting mortality for patients with COVID-19. Many scoring systems have been reported based on the biochemical and clinical parameters as age, D-dimer, presence of comorbidities, procalcitonin, C-reactive protein (CRP) and other features. Some of the reported scoring systems were recently developed in the COVID-19 pandemic while others were just modified based on the fact that patients with COVID-19 are critically ill, and usually require the same medical attention as other conditions. These scoring systems should be considered by clinicians to early predict and intervene against severe COVID-19 that might cause death. As for the imaging modalities, we have also reported many of the reported systems in the literature, including the ones that are based on chest computed tomography and X-ray findings, and are discussed in detail within this study.

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Modified Chest X-Ray Scoring System in Evaluating Severity of COVID-19 Patient in Dr. Soetomo General Hospital Surabaya, Indonesia

International Journal of General Medicine ◽

10.2147/ijgm.s310577 ◽

2021 ◽

Vol Volume 14 ◽

pp. 2407-2412

Author(s):

Rosy Setiawati ◽

Anita Widyoningroem ◽

Triwulan Handarini ◽

Fierly Hayati ◽

Agnes Triana Basja ◽

...

Keyword(s):

General Hospital ◽

Scoring System ◽

X Ray ◽

Chest X Ray

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Artificial Intelligence in Predicting Clinical Outcome in COVID-19 Patients from Clinical, Biochemical and a Qualitative Chest X-Ray Scoring System

Reports in Medical Imaging ◽

10.2147/rmi.s292314 ◽

2021 ◽

Vol Volume 14 ◽

pp. 27-39

Author(s):

Andrea Esposito ◽

Elena Casiraghi ◽

Francesca Chiaraviglio ◽

Alice Scarabelli ◽

Elvira Stellato ◽

...

Keyword(s):

Artificial Intelligence ◽

Clinical Outcome ◽

Scoring System ◽

X Ray ◽

Chest X Ray

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Role of Chest X-ray abnormalities in predicting outcome of COVID-19 in Young Adult Patient

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v14i3.54678 ◽

2021 ◽

pp. 30-35

Author(s):

Rawnak Jahan ◽

Mohammed Atiqur Rahman ◽

AKM Mosharraf Hossain ◽

Shamim Ahmed ◽

Rajashish Chakrabortty ◽

...

Keyword(s):

Young Adult ◽

Ct Scan ◽

Adult Patient ◽

Scoring System ◽

Radiology Department ◽

P Value ◽

X Ray ◽

Young Adult Patient ◽

Increased Risk ◽

Chest X Ray

COVID-19 is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Recently COVID -19 radiological literature focuses primarily on CT scan findings which are more sensitive (about 97%) and specific than chest x-ray. But it has to be remembered that performing CT scan is not easy during this pandemic situation. So, the aim of the study was to analyze the chest x-ray severity scoring system and its association with outcome in a young adult patient with COVID-19. This cross-sectional study was carried out from September 15 to December 31 2020 in the COVID unit of BSMMU and it included 100 RT-PCR positive COVID-19 patients according to selection criteria. Chest x-ray postero-anterior view was done in the radiology department of BSMMU. Each patient’s chest x-ray was examined by a radiologist and a pulmonologist with experience of 10 years. Radiological scoring was done by using a scoring system. All patients were followed after 20 days from the first presentation to see the outcome. Out of 100 patients, 73 patients (73%) needed hospital admission, 33(33%) patients were hospitalized but did not developed sepsis, 29 (29%) patient developed sepsis, 10(10%) patient needed ICU support among them 2 patients got intubation. 1(1%) patient was dead. Radiological score ≥ 4 was associated with increased risk of hospitalization. (Area under curve = 0.956). Score ≥ 5 was associated with increased risk of sepsis; score ≥7 was associated with increased risk of ICU admission. (p-value<0.001). BSMMU J 2021; 14 (COVID -19 Supplement): 30-35

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COVID-19 outbreak in Italy: Experimental chest x-ray scoring system for quantifying and monitoring disease progression

10.21203/rs.3.rs-19842/v1 ◽

2020 ◽

Author(s):

Andrea Borghesi ◽

Roberto Maroldi

Keyword(s):

Scoring System ◽

Early Stage ◽

Pulmonary Involvement ◽

Hospitalized Patients ◽

Rapid Progression ◽

Emergency Setting ◽

Early Stage Disease ◽

X Ray ◽

Lung Abnormalities ◽

Chest X Ray

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus recently isolated from humans. SARS-CoV-2 was discovered to be the pathogen responsible for a cluster of pneumonia associated with severe respiratory disease occurred in December 2019 in China. This novel pulmonary infection, formally called coronavirus disease 2019 (COVID-19), has spread rapidly in China and beyond. On 8 March 2020, the number of Italians with SARS-CoV-2 infection was 7375 with a 48% hospitalization rate. At present, chest computed tomography imaging is considered the most effective method for detection of lung abnormalities in early-stage disease and for quantitative assessment of severity and progression of COVID-19 infection. Although chest x-ray (CXR) is considered not sensitive for the detection of pulmonary involvement in the early stage of disease, we believe that, in the current emergency setting, CXR can be a useful diagnostic tool for monitoring the rapid progression of lung abnormalities in infected patients, particularly in intensive care units. In this article we present our experimental CXR scoring system that we are applying in hospitalized patients with COVID-19 pneumonia to quantify and monitor the severity and progression of this new infectious disease. We also present the results of our preliminary validation study on a sample of 100 hospitalized patients with SARS-CoV-2 infection for whom the final outcome (recovery or death) was available.

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