Chest X-ray for predicting mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.

OBJECTIVES: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support METHODS: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation Two scoring systems (Brixia score and percentage of lung involvement) were applied Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC) Predictors of death and respiratory support were identified by logistic or Poisson regression RESULTS: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0 90), Brixia score (ICC = 0 91), and percentage of lung involvement (ICC = 0 95) The Brixia score (OR: 1 19;95% CI: 1 06, 1 34;p = 0 003), age (OR: 1 16;95% CI: 1 11, 1 22;p < 0 001), PaO(2)/FiO(2) ratio (OR: 0 99;95% CI: 0 98, 1;p = 0 002), and cardiovascular diseases (OR: 3 21;95% CI: 1 28, 8 39;p = 0 014) predicted death Percentage of lung involvement (OR: 1 02;95% CI: 1 01, 1 03;p = 0 001) and PaO(2)/FiO(2) ratio (OR: 0 99;95% CI: 0 99, 1 00;p < 0 001) were significant predictors of the need for ventilatory support CONCLUSIONS: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO(2)/FiO(2) ratio, and SpO(2) values to early predict mortality and the need for ventilatory support KEY POINTS: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO(2)/FIO(2) ratio, and SpO(2) values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department