COVID-2019 pneumonia : severity and distribution of lung changes observed on the initial chest X-ray as an indicator of final outcomes

Abstract EN

Objectives: This study aimed to assess the correlation between the severity of the initial chest x-ray (CXR) abnormalities in patients with a confirmed diagnosis of COVID-19 and the final outcomes.

Methods: This retrospective study was conducted at the Royal Hospital, Oman between mid-March and May 2020 and included patients who had been admitted with a confirmed diagnosis of COVID-19 and had a final outcome.

Serial CXRs were identified and examined for presence, extent, distribution and progression pattern of radiological abnormalities.

Each lung field was divided into three zones on each CXR and a score was allocated for each zone (0 is normal and 1–4 is mild–severe).

The scores for all six zones per CXR examination were summed to provide a cumulative chest radiographic score (range: 0–24).

Results: A total of 64 patients were included; the majority were male (89.1%) and the mean age was 50.22 ± 14.86 years.

The initial CXR was abnormal in 60 patients (93.8%).

The most common finding was ground glass opacity (n = 58, 96.7%) followed by consolidation (n = 50, 83.3%).

Most patients had bilateral (n = 51, 85.0%), multifocal (n = 57, 95.0%) and mixed central and peripheral (n = 36, 60.0%) lung abnormalities.

The median score of initial CXR for deceased patients was significantly higher than recovered patients (17 versus 11; P = 0.009).

Five CXR evolution patterns were identified: type I (initial radiograph deteriorates then improves), type II (fluctuate), type III (static), type IV (progressive deterioration) and type V (progressive improvement).

Conclusion: A higher baseline CXR score is associated with higher mortality rate and poor prognosis in those with COVID-19 pneumonia.