Key Results1. Among a 787-patient cohort with confirmed COVID-19, three chest radiograph scores (BRIXIA, RALE, and percent opacification) all had good interrater reliability with intraclass correlations of 0.87, 0.86, and 0.72 respectively.2. Radiograph scores predicted intensive care unit (ICU) admission or death after COVID-19 diagnosis. A 50%-75% opacification (compared to 0%-25%) associated with a 2.2-fold increase in these outcomes among those eligible for ICU care after adjustment for clinical risk scoring. SummaryBRIXIA, RALE, and percent opacification produced reliable and reproducible COVID-19 chest radiograph severity scores that improved accuracy for predicting adverse outcomes when incorporated into ISARIC-4C mortality and NEWS2 clinical scoring systems. I n p r e s s ResultsAdmission chest radiographs of 50 patients (mean age, 74 years +/-16 [sd], 28 men) were scored by all 3 radiologists, with good inter-rater reliability for all scores (ICCs (95% CIs) of for RALE 0.87 (0.80, 0.92), BRIXIA 0.86 (0.76, 0.92), and percentage opacification 0.72 (0.48, 0.85)). Of 751 patients with chest radiograph, those with >75% opacification had a median time to ICU admission or death of just 1-2 days. Among 628 patients with data (median age 76 years (IQR 61 -84), and 344 were men), 50-75% opacification increased risk of ICU admission or death by twofold (1.6 -2.8), and over 75% opacification by 4 fold (3.4 -4.7), compared to a 0-25% opacification when adjusted for NEWS2 score. ConclusionBRIXIA, RALE, and percent opacification scores all reliably predicted adverse outcomes in SARS-CoV-2.

ImportancePatients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services.ObjectivesTo examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups.Design, Setting, and ParticipantsThis was a population-based case-control study in England conducted from January 1, 2001, through December 31, 2019. Data were obtained from multiple linked electronic records from primary care, secondary care, and the Office for National Statistics. Included participants were all patients 15 years or older and registered in the Office for National Statistics in England with a death coded as suicide or open verdict from 2001 to 2019. Up to 40 live control participants per suicide case were randomly matched on primary care practice and suicide date.ExposuresPatients with codes referring to a dementia diagnosis were identified in primary care and secondary care databases.Main Outcomes and MeasuresOdds ratios (ORs) were estimated using conditional logistic regression and adjusted for sex and age at suicide/index date.ResultsFrom the total sample of 594 674 patients, 580 159 (97.6%) were controls (median [IQR] age at death, 81.6[72.0-88.4] years; 289 769 male patients [50.0%]), and 14 515 (2.4%) died by suicide (median [IQR] age at death, 47.4 [36.0-59.7] years; 10 850 male patients [74.8%]). Among those who died by suicide, 95 patients (1.9%) had a recorded dementia diagnosis (median [IQR] age at death, 79.5 [67.1-85.5] years; median [IQR] duration of follow-up, 2.3 [1.0-4.4] years). There was no overall significant association between a dementia diagnosis and suicide risk (adjusted OR, 1.05; 95% CI, 0.85-1.29). However, suicide risk was significantly increased in patients diagnosed with dementia before age 65 years (adjusted OR, 2.82; 95% CI, 1.84-4.33), in the first 3 months after diagnosis (adjusted OR, 2.47; 95% CI, 1.49-4.09), and in patients with dementia and psychiatric comorbidity (adjusted OR, 1.52; 95% CI, 1.21-1.93). In patients younger than 65 years and within 3 months of diagnosis, suicide risk was 6.69 times (95% CI, 1.49-30.12) higher than in patients without dementia.Conclusions and RelevanceDiagnostic and management services for dementia, in both primary and secondary care settings, should target suicide risk assessment to the identified high-risk groups.

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