Department of Radiology, Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.
Department of Internal Medicine, Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.
J Korean Med Sci. 2023 Jul 3;38(26):e199. doi: 10.3346/jkms.2023.38.e199.
The Fleischner Society established consensus guidelines for imaging in patients with coronavirus disease 2019 (COVID-19). We investigated the prevalence of pneumonia and the adverse outcomes by dividing groups according to the symptoms and risk factors of patients and assessed the suitability of the Fleischner society imaging guidelines in evaluating chest radiographs of COVID-19 patients.
From February 2020 to May 2020, 685 patients (204 males, mean 58 ± 17.9 years) who were diagnosed with COVID-19 and hospitalized were included. We divided patients into four groups according to the severity of symptoms and presence of risk factors (age > 65 years and presence of comorbidities). The patient groups were defined as follows: group 1 (asymptomatic patients), group 2 (patients with mild symptoms without risk factors), group 3 (patients with mild symptoms and risk factors), and group 4 (patients with moderate to severe symptoms). According to the Fleischner society, chest imaging is not indicated for groups 1-2 but is indicated for groups 3-4. We compared the prevalence and score of pneumonia on chest radiographs and compare the adverse outcomes (progress to severe pneumonia, intensive care unit admission, and death) between groups.
Among the 685 COVID-19 patients, 138 (20.1%), 396 (57.8%), 102 (14.9%), and 49 (7.1%) patients corresponded to groups 1 to 4, respectively. Patients in groups 3-4 were significantly older and showed significantly higher prevalence rates of pneumonia (group 1-4: 37.7%, 51.3%, 71.6%, and 98%, respectively, < 0.001) than those in groups 1-2. Adverse outcomes were also higher in groups 3-4 than in groups 1-2 (group 1-4: 8.0%, 3.5%, 6.9%, and 51%, respectively, < 0.001). Patients with adverse outcomes in group 1 were initially asymptomatic but symptoms developed during follow-up. They were older (mean age, 80 years) and most of them had comorbidities (81.8%). Consistently asymptomatic patients had no adverse events.
The prevalence of pneumonia and adverse outcomes were different according to the symptoms and risk factors in COVID-19 patients. Therefore, as the Fleischner Society recommended, evaluation and monitoring of COVID-19 pneumonia using chest radiographs is necessary for old symptomatic patients with comorbidities.
弗莱舍纳学会为 2019 年冠状病毒病（COVID-19）患者的影像学制定了共识指南。我们根据患者的症状和危险因素将患者分组，以评估肺炎的发生率和不良结局，并评估弗莱舍纳学会影像学指南在评估 COVID-19 患者胸部 X 线片方面的适用性。
2020 年 2 月至 2020 年 5 月，共纳入 685 例（204 例男性，平均年龄 58±17.9 岁）COVID-19 住院患者。我们根据症状严重程度和危险因素（年龄>65 岁和合并症）将患者分为四组。患者组定义如下：第 1 组（无症状患者）、第 2 组（无危险因素的轻症患者）、第 3 组（有危险因素的轻症患者）和第 4 组（中重度症状患者）。根据弗莱舍纳学会的建议，第 1-2 组不需要进行胸部影像学检查，而第 3-4 组需要进行。我们比较了胸部 X 线片上肺炎的发生率和评分，并比较了各组之间的不良结局（进展为重症肺炎、入住重症监护病房和死亡）。
在 685 例 COVID-19 患者中，第 1-4 组分别有 138 例（20.1%）、396 例（57.8%）、102 例（14.9%）和 49 例（7.1%）。第 3-4 组患者明显较年长，且肺炎发生率明显较高（第 1-4 组分别为 37.7%、51.3%、71.6%和 98%，均<0.001）。第 3-4 组的不良结局也高于第 1-2 组（第 1-4 组分别为 8.0%、3.5%、6.9%和 51%，均<0.001）。第 1 组中发生不良结局的患者最初无症状，但在随访期间出现症状。他们年龄较大（平均年龄 80 岁），且大多合并有基础疾病（81.8%）。一直无症状的患者无不良事件发生。
COVID-19 患者的肺炎发生率和不良结局因症状和危险因素而异。因此，根据弗莱舍纳学会的建议，对于有症状的老年合并症患者，有必要使用胸部 X 线片评估和监测 COVID-19 肺炎。
