Department of Radiology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
University of Milano-Bicocca, Milan, Italy.
Eur Radiol. 2021 Apr;31(4):1999-2012. doi: 10.1007/s00330-020-07270-1. Epub 2020 Oct 8.
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.
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.
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/FiO 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/FiO ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support.
CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO/FiO ratio, and SpO values to early predict mortality and the need for ventilatory support.
• 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/FIO ratio, and SpO values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.
评估 2019 年冠状病毒病（COVID-19）胸部 X 线（CXR）表现的观察者间一致性，并确定初始 CXR 以及急诊科就诊时的人口统计学、临床和实验室数据对预测死亡率和通气支持需求的价值。
回顾性纳入 2020 年 3 月 1 日至 13 日在急诊科接受 CXR 的 340 例 COVID-19 患者。两名观察者独立评估 CXR 异常，包括磨玻璃影（GGO）和实变。应用两种评分系统（Brixia 评分和肺受累百分比）。采用加权 Cohen's κ（κ）或组内相关系数（ICC）评估观察者间一致性。通过逻辑或泊松回归识别死亡和呼吸支持的预测因素。
GGO 混合实变（n=235，69%）是最常见的 CXR 表现。实质混浊类型（κ=0.90）、Brixia 评分（ICC=0.91）和肺受累百分比（ICC=0.95）的观察者间一致性几乎为完美。Brixia 评分（OR：1.19；95%CI：1.06，1.34；p=0.003）、年龄（OR：1.16；95%CI：1.11，1.22；p<0.001）、PaO/FiO 比值（OR：0.99；95%CI：0.98，1；p=0.002）和心血管疾病（OR：3.21；95%CI：1.28，8.39；p=0.014）预测死亡。肺受累百分比（OR：1.02；95%CI：1.01，1.03；p=0.001）和 PaO/FiO 比值（OR：0.99；95%CI：0.99，1.00；p<0.001）是需要通气支持的显著预测因素。
CXR 是评估 COVID-19 的一种可重复的工具，与患者病史、PaO/FiO 比值和 SpO 值相结合，可早期预测死亡率和通气支持的需求。
CXR 是评估 COVID-19 肺炎的一种可重复的工具。
CXR 的 Brixia 评分和肺受累百分比与患者病史、PaO/FIO 比值和 SpO 值相结合，可早期预测 COVID-19 患者就诊急诊科时的死亡率和通气支持需求。
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