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Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study.
Eur Radiol Exp. 2020 12 15; 4(1):68.ER

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.

Authors+Show Affiliations

Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.Unit of Radiology, Ospedale Lavagna, Via Don Giovanni Battista Bobbio 25, 16033, Lavagna, Italy.Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy. schiaffino.simone@gmail.com.Unit of Radiology, Ospedale Lavagna, Via Don Giovanni Battista Bobbio 25, 16033, Lavagna, Italy.Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.Unit of Radiology, Ospedale Lavagna, Via Don Giovanni Battista Bobbio 25, 16033, Lavagna, Italy.Unit of Radiology, Ospedale Lavagna, Via Don Giovanni Battista Bobbio 25, 16033, Lavagna, Italy.Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milan, Italy.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33319321

Citation

Monaco, Cristian Giuseppe, et al. "Chest X-ray Severity Score in COVID-19 Patients On Emergency Department Admission: a Two-centre Study." European Radiology Experimental, vol. 4, no. 1, 2020, p. 68.
Monaco CG, Zaottini F, Schiaffino S, et al. Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study. Eur Radiol Exp. 2020;4(1):68.
Monaco, C. G., Zaottini, F., Schiaffino, S., Villa, A., Della Pepa, G., Carbonaro, L. A., Menicagli, L., Cozzi, A., Carriero, S., Arpaia, F., Di Leo, G., Astengo, D., Rosenberg, I., & Sardanelli, F. (2020). Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study. European Radiology Experimental, 4(1), 68. https://doi.org/10.1186/s41747-020-00195-w
Monaco CG, et al. Chest X-ray Severity Score in COVID-19 Patients On Emergency Department Admission: a Two-centre Study. Eur Radiol Exp. 2020 12 15;4(1):68. PubMed PMID: 33319321.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study. AU - Monaco,Cristian Giuseppe, AU - Zaottini,Federico, AU - Schiaffino,Simone, AU - Villa,Alessandro, AU - Della Pepa,Gianmarco, AU - Carbonaro,Luca Alessandro, AU - Menicagli,Laura, AU - Cozzi,Andrea, AU - Carriero,Serena, AU - Arpaia,Francesco, AU - Di Leo,Giovanni, AU - Astengo,Davide, AU - Rosenberg,Ilan, AU - Sardanelli,Francesco, Y1 - 2020/12/15/ PY - 2020/06/06/received PY - 2020/11/10/accepted PY - 2020/12/15/entrez PY - 2020/12/16/pubmed PY - 2020/12/29/medline KW - COVID-19 KW - COVID-19 diagnostic testing KW - Chest x-ray KW - Diagnostic imaging KW - Severity score SP - 68 EP - 68 JF - European radiology experimental JO - Eur Radiol Exp VL - 4 IS - 1 N2 - 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. SN - 2509-9280 UR - https://www.unboundmedicine.com/medline/citation/33319321/Chest_x_ray_severity_score_in_COVID_19_patients_on_emergency_department_admission:_a_two_centre_study_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33319321/ DB - PRIME DP - Unbound Medicine ER -