CXR severity scores of COVID 19 infection in Sri Lanka: findings of a multicenter study during the first wave of the pandemic

Abstract

Introduction: Chest X-ray initially remained the only imaging modality in the first wave of the COVID -19 pandemic in Sri Lanka similar to many other low resource settings. Sri Lanka claimed a cluster epidemic status achieving a case fatality rate well below the global rate during the first wave. Objectives: To describe degree of lung involvement on CXR as a severity score and correlate severity scores with symptom duration, presence of comorbidities and demographic factors. Methods: A retrospective study at four main hospitals in Sri Lanka included all RT-PCR positive COVID-19 patients who underwent CXR from January to mid May, 2020. Both initial and follow-up CXR were independently double reported by a team of four radiologists and discrepancy reported by a fifth radiologist for radiographic findings and lung involvement. Clinical and demographic data was retrieved from hospital records. A severity score was calculated for each CXR. Associations were analyzed for CXRs with a severity score of 1 or more. Results: 217 CXRs of 133 patients (99 men, mean age 43.9±15.7 years;133 initial CXRs of 132 symptomatic patients; 84 follow-up radiographs of 33 patients) revealed 96(96/133;72.2%) normal initial CXRs. 12 patients with normal initial CXRs(12/96;12.5%) underwent follow up CXR but none was abnormal. Majority (21/37;56.75%) with abnormal CXR had mild (severity score 1-2) lung involvement. A severity score of 1 or more was associated with comorbidities (OR=3.14), male sex (OR=5.93) and increasing age (OR=1.06). Conclusion: Majority of CXR in COVID-19 patients were normal during first wave in Sri Lanka. Majority with abnormal CXR had mild lung involvement.