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ED Chest X-Ray Score Predicts COVID-19 Outcomes in Adults <50

FRIDAY, May 22, 2020 -- A chest X-ray (CXR) severity score can predict outcomes among young and middle-aged adults with COVID-19 on presentation to the emergency department, according to a study published online May 14 in Radiology.

Danielle Toussie, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues analyzed the prognostic value of a CXR severity scoring system for 338 younger patients with COVID-19 on presentation to the emergency department. Data were included for patients aged 21 to 50 years who presented to emergency departments from March 10 to 26, 2020, with confirmed COVID-19. Each CXR was divided into six zones and was examined for opacities, with scores collated into a total lung zone severity score.

The researchers found that independent predictors of hospital admission were CXR severity score ≥2 (odds ratio, 6.2) and obesity (odds ratio, 2.4) or morbid obesity after adjustment for demographics and comorbidities. A CXR score ≥3 was an independent predictor of intubation (odds ratio, 4.7), as was hospital site, among patients who were admitted. The primary outcomes did not differ significantly across race/ethnicity or with history of tobacco use, asthma, or type 2 diabetes.

"These results underscore how COVID-19, despite its many nonrespiratory manifestations, is primarily a respiratory illness and the lung parenchymal changes -- as seen on chest radiography as opacification -- are the primary driver of disease progression," the authors write. "These findings allow for identification of high-risk patients while minimizing anchoring heuristics that may be present among clinicians in high-volume settings."

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Posted: May 2020

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