Abstract
BackgroundChest radiography has not been validated for its prognostic utility in evaluating patients with coronavirus disease 2019 (COVID-19).PurposeTo analyze the prognostic value of a chest radiograph severity scoring system for younger (nonelderly) patients with COVID-19 at initial presentation to the emergency department (ED); outcomes of interest included hospitalization, intubation, prolonged stay, sepsis, and death.Materials and MethodsIn this retrospective study, patients between the ages of 21 and 50 years who presented to the ED of an urban multicenter health system from March 10 to March 26, 2020, with COVID-19 confirmation on real-time reverse transcriptase polymerase chain reaction were identified. Each patient’s ED chest radiograph was divided into six zones and examined for opacities by two cardiothoracic radiologists, and scores were collated into a total concordant lung zone severity score. Clinical and laboratory variables were collected. Multivariable logistic regression was used to evaluate the relationship between clinical parameters, chest radiograph scores, and patient outcomes.ResultsThe study included 338 patients: 210 men (62%), with median age of 39 years (interquartile range, 31–45 years). After adjustment for demographics and comorbidities, independent predictors of hospital admission (n = 145, 43%) were chest radiograph severity score of 2 or more (odds ratio, 6.2; 95% confidence interval [CI]: 3.5, 11; P < .001) and obesity (odds ratio, 2.4 [95% CI: 1.1, 5.4] or morbid obesity). Among patients who were admitted, a chest radiograph score of 3 or more was an independent predictor of intubation (n = 28) (odds ratio, 4.7; 95% CI: 1.8, 13; P = .002) as was hospital site. No significant difference was found in primary outcomes across race and ethnicity or those with a history of tobacco use, asthma, or diabetes mellitus type II.ConclusionFor patients aged 21–50 years with coronavirus disease 2019 presenting to the emergency department, a chest radiograph severity score was predictive of risk for hospital admission and intubation.© RSNA, 2020Online supplemental material is available for this article.
Highlights
E purpose of this study was to determine the relationship between the clinical and the initial chest radiography findings and the outcome variables of hospital admission and/or intubation in patients with COVID-19 between the ages of 21 and 50 years
Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China, in December 2019 [1]
Chest radiography has become the primary imaging modality used for clinical management
Summary
The purpose of this study was to determine the relationship between the clinical and the initial chest radiography findings and the outcome variables of hospital admission and/or intubation in patients with COVID-19 between the ages of 21 and 50 years
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