The role of initial chest X-ray in triaging patients with suspected COVID-19 during the pandemic
The role of initial chest X-ray in triaging patients with suspected COVID-19 during the pandemic
复制标题
DOI：
10.1007/s10140-020-01808-y
复制
发表时间：
2020-06-22
影响因子：
2.2
通讯作者：
Salvatore, Mary
中科院分区：
文献类型：
--
作者：
Kim, Hyunjoong W.;Capaccione, K. M.;Salvatore, Mary
目的本研究的目的是评估胸部X线检查对疑似COVID-19感染患者分诊的有用性。方法获得IRB批准，允许对2020年3月12日至2020年3月26日期间因发热、咳嗽、呼吸困难或缺氧到急诊室就诊并接受胸部X线检查的成人患者进行回顾性审查。初始胸部X射线以0-3的等级分级，其中0级表示没有肺泡混浊，1级：< 1/3的肺肺泡混浊，2级：1/3至2/3的肺具有肺泡混浊，3级：> 2/3的肺肺泡混浊。还收集了既往糖尿病和高血压病史、初始血氧饱和度、COVID-19检测结果、插管和结局。结果410例患者的胸部X线片进行了审查。氧饱和度和X线分级均与住院时间显著相关，出院风险比（HR）分别为1.05（95%CI [1.01，1.09]，p = 0.017）和0.61（95%CI [0.51，0.73]，p < 0.001）。此外，血氧饱和度和X线分级是插管的重要预测因素（插管的比值比（OR）为0.88（95% CI [0.81，0.96]，p = 0.004）和3.69（95% CI [2.25，6.07]，p < 0.001）。结论初始胸部X线检查是一种有用的工具，可用于对那些可能因疑似COVID-19感染而预后不良且住院受益最大的受试者进行分诊。
Purpose The purpose of our research is to evaluate the usefulness of chest X-ray for triaging patients with suspected COVID-19 infection. Methods IRB approval was obtained to allow a retrospective review of adult patients who presented to the Emergency Department with a complaint of fever, cough, dyspnea or hypoxia and had a chest X-ray between 12 March 2020 and 26 March 2020. The initial chest X-ray was graded on a scale of 0-3 with grade 0 representing no alveolar opacities, grade 1: < 1/3 alveolar opacities of the lung, Grade 2: 1/3 to 2/3 lung with alveolar opacities and grade 3: > 2/3 alveolar opacities of the lung. Past medical history of diabetes and hypertension, initial oxygen saturation, COVID-19 testing results, intubation, and outcome were also collected. Results Four hundred ten patient chest X-rays were reviewed. Oxygen saturation and X-ray grade were both significantly associated with the length of stay in hospital, the hazard ratio (HR) of discharge was 1.05 (95% CI [1.01, 1.09],p = 0.017) and 0.61 (95% CI [0.51, 0.73],p < 0.001), respectively. In addition, oxygen saturation and X-ray grade were significant predictors of intubation (odds ratio (OR) of intubation is 0.88 (95% CI [0.81, 0.96],p = 0.004) and 3.69 (95% CI [2.25, 6.07],p < 0.001). Conclusions Initial chest X-ray is a useful tool for triaging those subjects who might have poor outcomes with suspected COVID-19 infection and benefit most from hospitalization.