Diagnostic and Prognostic Value of Chest Radiographs for COVID-19 at Presentation.
Diagnostic and Prognostic Value of Chest Radiographs for COVID-19 at Presentation.
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DOI：
10.5811/westjem.2020.7.48842
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发表时间：
2020-08-17
期刊：
影响因子：
--
通讯作者：
Marom EM
中科院分区：
文献类型：
--
作者：
Kerpel A;Apter S;Nissan N;Houri-Levi E;Klug M;Amit S;Konen E;Marom EM
COVID-19的肺部混浊在整个疾病过程中增加，并在10天后达到峰值。放射学文献主要集中在CT表现。本研究的目的是评估胸部X光片（CXR）对2019冠状病毒病（COVID-19）的诊断和预后价值。我们回顾性地确定了连续逆转录聚合酶反应确诊的COVID-19患者（n = 104，75%男性）和反复阴性的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）检测患者（n = 75，51%男性）。两名放射科医生盲法独立审查了CXR，记录了结果，分配了肺水肿放射学评估（RALE）评分，并预测了患者的COVID-19状态。我们计算了观察者间的可靠性。使用受试者工作特征曲线下面积评估用于COVID-19诊断和预后的评分。总体RALE评分未能在就诊时识别COVID-19患者。然而，该评分与≤2天内的COVID-19诊断呈负相关，并且在症状发作后6天发现正相关。观察者之间关于区分正常与异常CXR的一致性为中等（k = 0.408），特异性较低（25%和27%）。明确的胸腔积液几乎完全一致（k = 0.833），大大降低了COVID-19诊断的几率。疾病分布和专家对COVID-19状况的意见在观察者之间只有公平的一致性。RALE评分的观察者间信度为中度至良好（组内相关系数= 0.745）。高RALE评分预测COVID-19患者的不良结局（重症监护室住院、插管或死亡）;评分≥5显著增加了不良结局的几率。胸部X光检查被发现不是COVID-19的有效诊断工具，因为正常或接近正常的CXR更有可能在病程早期出现。出现胸腔积液提示诊断为COVID-19以外的疾病。在COVID-19患者中，就诊时更广泛的肺部阴影与预后不良相关。因此，应密切监测具有超过最小浑浊的患者的临床恶化。CXR的这种临床应用是其在COVID-19中的最大优势，因为它影响了患者护理。
Pulmonary opacities in COVID-19 increase throughout the illness and peak after ten days. The radiological literature mainly focuses on CT findings. The purpose of this study was to assess the diagnostic and prognostic value of chest radiographs (CXR) for coronavirus disease 2019 (COVID-19) at presentation. We retrospectively identified consecutive reverse transcription polymerase reaction-confirmed COVID-19 patients (n = 104, 75% men) and patients (n = 75, 51% men) with repeated negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests. Two radiologists blindly and independently reviewed the CXRs, documented findings, assigned radiographic assessment of lung edema (RALE) scores, and predicted the patients’ COVID-19 status. We calculated interobserver reliability. The score use for diagnosis and prognosis of COVID-19 was evaluated with the area under the receiver operating characteristic curve. The overall RALE score failed to identify COVID-19 patients at presentation. However, the score was inversely correlated with a COVID-19 diagnosis within ≤2 days, and a positive correlation was found six days after symptom onset.Interobserver agreement with regard to separating normal from abnormal CXRs was moderate (k = 0.408) with low specificity (25% and 27%). Definite pleural effusion had almost perfect agreement (k = 0.833) and substantially reduced the odds of a COVID-19 diagnosis. Disease distribution and experts’ opinion on COVID-19 status had only fair interobserver agreement. The RALE score interobserver reliability was moderate to good (intraclass correlation coefficient = 0.745). A high RALE score predicted a poor outcome (intensive care unit hospitalization, intubation, or death) in COVID-19 patients; a score of ≥5 substantially increased the odds of having a poor outcome. Chest radiography was found not to be a valid diagnostic tool for COVID-19, as normal or near-normal CXRs are more likely early in the disease course. Pleural effusions at presentation suggest a diagnosis other than COVID-19. More extensive lung opacities at presentation are associated with poor outcome in COVID-19 patients. Thus, patients with more than minimal opacities should be monitored closely for clinical deterioration. This clinical application of CXR is its greatest strength in COVID-19 as it impacts patient care.
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