P9 Do persistent chest radiograph changes correlate with ongoing respiratory symptoms in patients recovering from COVID-19 pneumonia?

Abstract

<h3>Introduction and Objectives</h3> In May 2020, BTS published guidelines on radiological follow-up for patients with COVID-19 pneumonia, advising an initial repeat chest radiograph at 12 weeks to assess resolution.¹ It is unclear whether persistent chest radiograph changes are clinically significant. Our aim was to assess whether there is a correlation between post-COVID chest radiograph appearances and ongoing respiratory symptoms. <h3>Methods</h3> Inpatients at two trust hospital sites diagnosed with COVID-19, either clinically or from a positive nasopharyngeal swab, were followed-up via telephone approximately 6–8 weeks post-discharge. Patients were offered a chest radiograph and blood tests if abnormal and a symptomatic assessment via a proforma. Patients subjectively rated their degree of breathlessness, cough and fatigue using a numerical rating scale. Chest radiograph reports were coded by consultant radiologists as per BSTI guidelines² and grouped into ‘improvers’ (PCVCX0/1) and ‘non-improvers’ (PCVCX2/3 i.e. static or worsening appearances). Patients who had both an initial and follow-up chest radiograph, and who completed a proforma were included for retrospective analysis. <h3>Results</h3> 382 patients were included, with a median (IQR) time to follow-up of 56 days (44 – 68). Baseline characteristics are shown in <b>table 1.</b> 93% of patients had significantly improved radiographs. Patients with radiographs that were classified as ‘non-improvers’ were significantly more breathless subjectively compared to improvers [NRS 2 (0 – 4) vs. 1 (0 – 3), p= 0.01], [MRC scale 1 (1 – 3) vs. 1 (1 – 2), p= 0.021]. They were also more likely to have been admitted to ITU [10/26 (38.5%) vs. 41/356 (11.5%), p&lt; 0.001]. <h3>Conclusions</h3> In our cohort, patients recovering from COVID-19 pneumonia with a ‘non-improver’ chest radiograph are more likely to have been admitted to ITU and remain breathless at follow-up. We conclude that ‘non-improver’ chest radiographs at follow-up are an indicator of who may have ongoing respiratory pathology. These patients can thus be prioritised for further respiratory investigation. <h3>References</h3> British Thoracic Society (2020). Guidance on Respiratory Follow Up of Patients with a Clinico-Radiological Diagnosis of COVID-19 Pneumonia. https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/resp-follow-up-guidance-post-covid-pneumonia/ British Society of Thoracic Imaging (2020). Post-COVID-19 CXR Report Codes. https://www.bsti.org.uk/media/resources/files/BSTI_PostCOVIDCXRtemplatefinal.28.05.201.pdf