Current best evidence for clinical care (more info)
PURPOSE: To date, the majority of chest imaging studies in COVID-19 pneumonia have focused on CT. Evidence for the utility of chest radiographs (CXRs) in this population is less robust. Our objectives were to develop a systematic approach for reporting likelihood of COVID-19 pneumonia on CXRs, to measure the interobserver variability of this approach and to evaluate the diagnostic performance of CXRs compared to real-time reverse transcription polymerase chain reaction (RT-PCR).
METHOD: Retrospective review of patients suspected of having COVID-19 pneumonia who attended our emergency department and underwent both CXR and a RT-PCR were included. Two radiologists reviewed the CXRs, blind to the RT-PCR, and classified them according to a structured reporting template with five categories (Characteristic, High Suspicion, Indeterminate, Unlikely and Normal) which we devised. For analysis of diagnostic accuracy, Characteristic and High Suspicion CXRs were considered positive and the remaining categories negative. Concordance between the two assessors was also measured.
RESULTS: Of 582 patients (51 +/- 20 years), 143/582 (24.6 %) had a positive RT-PCR. The absolute concordance between the two assessors was 71.1 % (414/582) with a Fleiss-Cohen-weighted Cohen's ? of 0.81 (95 % confidence interval, 0.78-0.85). A patient with a positive CXR had an 88 % (95 % CI 80-96 %) probability of having a positive RT-PCR during a period of high incidence, early in the COVID-19 pandemic.
CONCLUSION: Using a structured approach, a positive CXR had a high likelihood of predicting a positive RT-PCR, with good interrater reliability. CXRs can be useful in identifying new cases of COVID-19.
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The majority of Chest imaging studies for COVID-19 have focused on CT. This research evaluated a chest X-ray structured reporting system for diagnosis of pneumonia with SARS-CoV-2 infections. The main contribution of this study is that the authors classified patients suspected to have COVID-19 into 5 X-ray patterns with different certainty of diagnosis.
We do far more chest films than CT scans on COVID-19 patients where I am employed. The description gives a framework for common/uncommon manifestations. The Positive LR is impressive. During a time when COVID-19 infections are high, the negative LR would still give me pause for a patient with high clinical likelihood.