Research Article
Role of Chest Radiography for evaluation and Severity Scoring in COVID-19 Pneumonia
Parate R1, Tiwari S1*, Parate T2 and Anand A1
1Government Medical College and Hospital, Medical Square, India
2Indira Gandhi Government Medical College and Hospital, India
*Corresponding author: Tiwari S, MBBS, MD Radiodiagnosis(ongoing), Government Medical College and Hospital, Medical Square, Nagpur, Maharashtra, India- 440003, Mailing address- 2, Shastri Layout, Subhash Nagar, Jaitala Road, Nagpur-440022, India, Ph. No. 9096710110; E-mail- shreeya.13.tiwari@gmail.com
Copyright: © 2020 Parate R, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article Information: Submission: 22/10/2020; Accepted: 04/12/2020; Published: 07/12/2020
Abstract
Objective: 1. Analysis of radiographic features of Covid-19 pneumonia upon initial presentation to the Emergency Department (ED).
2. Exploring the prognostic utility of chest radiograph by means of a semi-quantitative severity scoring system (modified RALE scoring) for patients with
COVID-19 pneumonia.
Materials and methods: In this retrospective study, patients presenting to two tertiary care center EDs with COVID-19 confirmation on real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) were identified. For these patients, the clinico-epidemiological data was recorded and chest radiograph was performed. Each patient’s radiograph was divided into 6 zones and examined for opacities. Both lung scores were collated into a total concordant severity score (0 to 8). Correlation between clinical status and radiological severity was looked for.
Results: Of the 1000 patients who had a positive RT-PCR for COVID-19, 611were males (61.1%) and 389 females (38.9%), with a mean age of 45.54 years (range 8-96 years). 423 (42.3%) patients were asymptomatic and 433(43.3%) chest radiographs had no radiological thoracic involvement. In the radiologically positive group, commonly observed alterations included: 397 patients (69.7%) with alveolar opacities, 191(33.5%) with consolidation,
62(10.8%) with diffuse radio-opacities and 100(17.5%) with coexistent alveolar opacities and consolidations. Peripheral (41.1%) and bilateral (76.08%) distribution of opacities was most striking. Chi 2 test showed a significant correlation between modified RALE scores and patient’s symptoms. Higher modified RALE score strongly correlated with symptomatic disease (Chi= 133.93, p<0.001).
Conclusion: Chest radiograph in COVID 19 pneumonia shows alveolar opacities or consolidation with peripheral and bilateral predominance. Modified RALE score can be used in the emergency setting as a semi-quantitative tool for prediction of clinical severity which is a direct indicator of disease outcome.