COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Diagnosis Moroni C, Cozzi D, Albanesi M, et al. Chest X-ray in the emergency department during COVID-19 pandemic descending phase in Italy: correlation with patients' outcome. Radiol Med. 2021 May;126(5):661-668. doi: 10.1007/s11547-020-01327-3. Epub 2021 Jan 4.

PURPOSE: The aims of our study are: (1) to estimate admission chest X-ray (CXR) accuracy during the descending phase of pandemic; (2) to identify specific CXR findings strictly associated with COVID-19 infection; and (3) to correlate lung involvement of admission CXR with patients' outcome.

MATERIALS AND METHODS: We prospectively evaluated the admission CXR of 327 patients accessed to our institute during the Italian pandemic descending phase (April 2020). For each CXR were searched ground glass opacification (GGO), consolidation (CO), reticular-nodular opacities (RNO), nodules, excavations, pneumothorax, pleural effusion, vascular congestion and cardiac enlargement. For lung alterations was defined the predominance (upper or basal, focal or diffuse, central or peripheric, etc.). Then radiologists assessed whether CXRs were suggestive or not for COVID-19 infection. For COVID-19 patients, a prognostic score was applied and correlated with the patients' outcome.

RESULTS: CXR showed 83% of specificity and 60% of sensitivity. GGO, CO, RNO and a peripheric, diffuse and basal prevalence showed good correlation with COVID-19 diagnosis. A logistic regression analysis pointed out GGO and a basal or diffuse distribution as independent predictors of COVID-19 diagnosis. The prognostic score showed good correlation with the patients' outcome.

CONCLUSION: In our study, admission CXR showed a fair specificity and a good correlation with patients' outcome. GGO and others CXR findings showed a good correlation with COVID-19 diagnosis; besides GGO a diffuse or bibasal distribution resulted in independent variables highly suggestive for COVID-19 infection thus enabling radiologists to signal to clinicians radiologically suspect patients during the pandemic descending phase.

Discipline / Specialty Area Score
Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Pediatric Hospital Medicine
Pediatric Emergency Medicine
Infectious Disease
Comments from MORE raters

Emergency Medicine rater

This is another study demonstrating mediocre accuracy of CXR in delineating COVID-19 from other causes of dyspnea or symptoms worrisome for COVID-19. It is not surprising that those with worse CXR findings might have worse outcomes; although, the data for this is not presented in a way that is really clinically interpretable. It's a very low yield read.

Emergency Medicine rater

This is very useful information for a physician working in a COVID-19 clinic.

Pediatric Emergency Medicine rater

This is not applicable to children.

Pediatric Emergency Medicine rater

The X-ray findings were more specific than sensitive. However the X-ray findings were not particularly unique. The youngest patient was 16 so the applicability to a pediatric population is unknown.

Pediatric Hospital Medicine rater

Most changes are non-specific for any respiratory infection. During the pandemic this may have its utility but not otherwise.

Respirology/Pulmonology rater

Nothing new.

Respirology/Pulmonology rater

This is very useful information. However, I think only two radiologists are not representative.