Background: Integration of imaging and clinical parameters could improve the stratification of COVID-19 patients on emergency department (ED) admission. We aimed to assess the extent of COVID-19 pulmonary abnormalities on chest x-ray (CXR) using a semiquantitative severity score, correlating it with clinical data and testing its interobserver agreement. Methods: From February 22 to April 8, 2020, 926 consecutive patients referring to ED of two institutions in Northern Italy for suspected SARS-CoV-2 infection were reviewed. Patients with reverse transcriptase-polymerase chain reaction positive for SARS-CoV-2 and CXR images on ED admission were included (295 patients, median age 69 years, 199 males). Five readers independently and blindly reviewed all CXRs, rating pulmonary parenchymal involvement using a 0–3 semiquantitative score in 1-point increments on 6 lung zones (range 0–18). Interobserver agreement was assessed with weighted Cohen’s κ, correlations between median CXR score and clinical data with Spearman’s ρ, and the Mann-Whitney U test. Results: Median score showed negative correlation with SpO2 (ρ = -0.242, p < 0.001), positive correlation with white cell count (ρ = 0.277, p < 0.001), lactate dehydrogenase (ρ = 0.308, p < 0.001), and C-reactive protein (ρ = 0.367, p < 0.001), being significantly higher in subsequently dead patients (p = 0.003). Considering overall scores, readers’ pairings yielded moderate (κ = 0.449, p < 0.001) to almost perfect interobserver agreement (κ = 0.872, p < 0.001), with better interobserver agreement between readers of centre 2 (up to κ = 0.872, p < 0.001) than centre 1 (κ = 0.764, p < 0.001). Conclusions: Proposed CXR pulmonary severity score in COVID-19 showed moderate to almost perfect interobserver agreement and significant but weak correlations with clinical parameters, potentially furthering CXR integration in patients’ stratification.

Chest x-ray severity score in COVID-19 patients on emergency department admission : a two-centre study / C.G. Monaco, F. Zaottini, S. Schiaffino, A. Villa, G. Della Pepa, L.A. Carbonaro, L. Menicagli, A. Cozzi, S. Carriero, F. Arpaia, G. Di Leo, D. Astengo, I. Rosenberg, F. Sardanelli. - In: EUROPEAN RADIOLOGY EXPERIMENTAL. - ISSN 2509-9280. - 4:1(2020), pp. 68.1-68.7. [10.1186/s41747-020-00195-w]

Chest x-ray severity score in COVID-19 patients on emergency department admission : a two-centre study

C.G. Monaco;G. Della Pepa;L.A. Carbonaro;L. Menicagli;A. Cozzi;S. Carriero;F. Arpaia;F. Sardanelli
2020

Abstract

Background: Integration of imaging and clinical parameters could improve the stratification of COVID-19 patients on emergency department (ED) admission. We aimed to assess the extent of COVID-19 pulmonary abnormalities on chest x-ray (CXR) using a semiquantitative severity score, correlating it with clinical data and testing its interobserver agreement. Methods: From February 22 to April 8, 2020, 926 consecutive patients referring to ED of two institutions in Northern Italy for suspected SARS-CoV-2 infection were reviewed. Patients with reverse transcriptase-polymerase chain reaction positive for SARS-CoV-2 and CXR images on ED admission were included (295 patients, median age 69 years, 199 males). Five readers independently and blindly reviewed all CXRs, rating pulmonary parenchymal involvement using a 0–3 semiquantitative score in 1-point increments on 6 lung zones (range 0–18). Interobserver agreement was assessed with weighted Cohen’s κ, correlations between median CXR score and clinical data with Spearman’s ρ, and the Mann-Whitney U test. Results: Median score showed negative correlation with SpO2 (ρ = -0.242, p < 0.001), positive correlation with white cell count (ρ = 0.277, p < 0.001), lactate dehydrogenase (ρ = 0.308, p < 0.001), and C-reactive protein (ρ = 0.367, p < 0.001), being significantly higher in subsequently dead patients (p = 0.003). Considering overall scores, readers’ pairings yielded moderate (κ = 0.449, p < 0.001) to almost perfect interobserver agreement (κ = 0.872, p < 0.001), with better interobserver agreement between readers of centre 2 (up to κ = 0.872, p < 0.001) than centre 1 (κ = 0.764, p < 0.001). Conclusions: Proposed CXR pulmonary severity score in COVID-19 showed moderate to almost perfect interobserver agreement and significant but weak correlations with clinical parameters, potentially furthering CXR integration in patients’ stratification.
Chest x-ray; COVID-19; COVID-19 diagnostic testing; Diagnostic imaging; Severity score
Settore MED/36 - Diagnostica per Immagini e Radioterapia
Settore MED/17 - Malattie Infettive
Article (author)
File in questo prodotto:
File Dimensione Formato  
s41747-020-00195-w.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 604.68 kB
Formato Adobe PDF
604.68 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/800610
Citazioni
  • ???jsp.display-item.citation.pmc??? 13
  • Scopus 16
  • ???jsp.display-item.citation.isi??? 2
social impact