Chest radiography evaluation in patients admitted with confirmed COVID-19 infection, in a resource limited South African isolation hospital

• Published in: SA journal of radiology 2022, Vol.26 (1), p.2262-2262
• Main Authors: Moodley, Sereesh, Sewchuran, Tanusha
• Format: Article
• Language: English
• Subjects: Bacterial pneumonia; brixia scoring system; Chest; Chest radiography; Chest X-ray; chest X-ray scoring system; Computed tomography; Coronaviruses; COVID-19; CT imaging; Development and progression; Health aspects; Health Care Sciences & Services; HIV; Human immunodeficiency virus; Infectious diseases; Medical research; Medicine, Experimental; Medicine, General & Internal; Mortality; Original Research; Patients; Pleural effusion; Pneumonia; Population studies; Public health; Radiography; Radiology, Nuclear Medicine & Medical Imaging; Resource Limited Setting; SARS-CoV-2; Scoring system; Severe acute respiratory syndrome coronavirus 2; South Africa; Tuberculosis; X-rays
• ISSN: 1027-202X; 2078-6778; 2078-6778
• DOI: 10.4102/sajr.v26i1.2262

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent global outbreak (coronavirus disease 2019 [COVID-19]) was declared a public health emergency in January 2020. Recent radiologic literature regarding COVID-19 has primarily focused on Computed Tomography (CT) chest findings, with chest radiography lacking in comparison.Objectives To describe the demographic profile of adult patients with COVID-19 pneumonia requiring hospital admission. To describe and quantify the imaging spectrum on chest radiography using a severity index, and to correlate the severity of disease with prognosis.Method Retrospective review of chest radiographs and laboratory records in patients admitted to a South African tertiary hospital with confirmed COVID-19 infection. The chest X-rays were systematically reviewed for several radiographic features, which were then quantified using the Brixia scoring system, and correlated to the patient’s outcome.Results A total of 175 patients (mean age: 53.34 years) admitted with COVID-19 were included. Ground glass opacification (98.9%), consolidation (86.3%), and pleural effusion (29.1%) was commonly found. Involvement of bilateral lung fields (96.6%) with no zonal predominance (61.7%), was most prevalent. Correlation between the Brixia score and outcome was found between severe disease and death (odds ratio [OR]: 12.86; 95% confidence interval [CI]: 1.58–104.61). Many patients had unknown TB (71.4%) and HIV (72.6%) statuses.Conclusion In this study population, ground glass opacification, consolidation, and pleural effusions, with bilateral lung involvement and no zonal predominance were the most prevalent findings in proven COVID-19 infection. Quantification using the Brixia scoring system may assist with timeous assessment of disease severity in COVID-19 positive patients, as an overall predicator of clinical outcome.