Abstract
COVID-19 ravaging through the world and third world countries with limited resources envisages a cost effective and feasible imaging and prognostication score. We aim to develop a prognostication score based on the first chest X-ray to assess deterioration and need to transfer to specialized treatment units should the wave of COVID – 19 surge to higher levels. A retrospective study reviewing chest X rays and case notes were analyzed by two radiologists and in case of disagreement a third radiologist was consulted. The lung changes were classified using Fleischner Society Glossary of Terms for Thoracic Imaging. Each lung was divided into 4 zones and a score of 1 given to each affected zone. The total score was used to prognosticate. Of the 146 patients there was a male preponderance. In 26.7%, the initial chest X-rays were abnormal. The peripheral, lower zone and bilateral involvement was more common. The scores of the initial chest X-ray correlated with the severity of the disease. With a sensitivity of 31.6%, chest X-ray is a poor screening investigation but with a specificity of 96.2% it can be used to prognosticate the outcome and monitor the progression of the disease.
Highlights
COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in December 2019
Chest X-ray (CXR) is the preferred mode of imaging in low and low-middle income countries considering the availability of infrastructure, proper personal protective equipment and carrying on uninterrupted non-COVID related radiological services
Materials and methods We carried out a retrospective, descriptive, hospital-based case note and CXR review at the Radiology Department and the COVID treating wards of the National Institute of Infectious Diseases (NIID), Angoda, Sri Lanka on all Sri Lankan patients above the age of 12 years, with a laboratory confirmed rt-PCR positive COVID-19 infection who have undergone a chest X-ray (CXR)
Summary
COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in December 2019. The World Health Organization declared COVID-19 a public health emergency of international concern in January 2020 and a pandemic on 11th March 2020. Sri Lanka’s first confirmed case was a 44-year-old Chinese female tourist from the Hubei Province in China. Computed tomography (CT) of the chest is the ideal imaging modality. Chest X-ray (CXR) is the preferred mode of imaging in low and low-middle income countries considering the availability of infrastructure, proper personal protective equipment and carrying on uninterrupted non-COVID related radiological services. With the surge in COVID -19 cases worldwide, Sri Lanka had to prepare for a possible escalation of cases with available resources. CXR is the readily accessible imaging modality in Sri Lanka and available in all levels of care from primary to tertiary care centres
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