Diagnostic impact of bedside chest X-ray features of 2019 novel coronavirus in the routine admission at the emergency department: case series from Lombardy region

Abstract

To evaluate the diagnostic accuracy and the imaging features of routine admission chest X-ray in patients suspected for novel Coronavirus 2019 (SARS-CoV-2) infection. Method: We retrospectively evaluated clinical and X-ray features in all patients referred to the emergency department for suspected SARS-CoV-2 infection between March 1st and March 13th. A single radiologist with more than 15 years of experience in chest-imaging evaluated the presence and extent of alveolar opacities, reticulations, and/or pleural effusion. The percentage of lung involvement (range < 25 % to 75-100 %) was also calculated. We stratified patients in groups according to the time interval between symptoms onset and X-ray imaging (≤ 5 and > 5 days) and according to age (≤ 50 and > 50 years old). Results: A total of 518 patients were enrolled. Overall 314 patients had negative and 204 had positive RT-PCR results. Lung lesions in patients with SARS-Cov2 pneumonia primarily manifested as alveolar and interstitial opacities and were mainly bilateral (60.8 %). Lung abnormalities were more frequent and more severe by symptom duration and by increasing age. The sensitivity and specificity of chest X-ray at admission in the overall cohort were 57 % (95 % CI = 47-67) and 89 % (83-94), respectively. Sensitivity was higher for patients with symptom onset > 5 days compared to ≤ 5 days (76 % [62-87] vs 37 % ) and in patients > 50 years old compared to ≤ 50 years (59 % [48-69] vs 47 % [23-72]), at the expense of a slightly lower specificity (68 % [45-86] and 82 % [73-89], respectively). Conclusions: Overall chest X-ray sensitivity for SARS-CoV-2 pneumonia was 57 %. Sensitivity was higher when symptoms had started more than 5 days before, at the expense of lesser specificity, while slightly higher in older patients in comparison to younger ones.

Baseline chest X-ray in coronavirus disease 19 (COVID-19) patients: association with clinical and laboratory data

“…To the best of our knowledge, there are only seven papers in the literature, excluding case reports and case series, evaluating the sensitivity of CXR in COVID-19 patients. Table 4 compares our results on sensitivity of CXR with those of the authors who performed similar estimates [7][8][9][10][11][12]. We found a sensitivity of CXR of 61.1% (95%CI 55-67%) in the identification of abnormalities in COVID-19 patients.…”

“…We found a sensitivity of CXR of 61.1% (95%CI 55-67%) in the identification of abnormalities in COVID-19 patients. Five studies, including ours, yield consistent 95%Confidence Intervals [7,[9][10][11]. There are two exceptions, at the two ends of the spectrum of values: the lower value reported by Weinstock et al [8], relative to patients admitted to urgent care centers, therefore likely to have a lower grade pathology, and the higher value reported by Schiaffano et al [12] for patients hospitalized in the Lombardy region, which might be due to the higher-grade pathology present in that region.…”

“…In Northern Italy, the epicenter of the Italian SARS-CoV-2 pandemic, some emergency departments use CXR as the first line of triage in patients with suspected COVID-19 also because of the relatively long waiting time for RT-PCR. Although, the common opinion is that CXR may not be sufficiently sensitive for the detection of COVID-19 lung disease especially in the early stages of the pathology, there are only a few studies in the literature assessing its sensitivity in respect to the current diagnostic gold standard, RT-PCR [7][8][9][10][11][12]. Furthermore, no pertinent information is available concerning the association of CXR findings with clinical and laboratory data.…”

Effects of prone and lateral position in non-intubated patients with 2019 Novel Coronavirus (COVID-19) pneumonia

“…Chest x-ray could be useful to support diagnosis, especially during Sars-cov 2 pandemic: sensitivity values range from 57% to 89%. 20 However, Chest-x-ray can not detect spared lung areas: exclusive dorsal lung areas involvement can not be detected without latero-lateral projection, not usually performed in critical setting, requiring orthostatic posture. As observed by Marini, 4 COVID-19 pneumonia appears to include an important vascular insult that potentially mandates a different approach from that usually applied for ARDS.…”

Atualização sobre a pandemia do COVID-19: uma revisão integrativa / Update on the COVID-19 pandemic: an integrative review

“…Nesse sentido, a radiografia de tórax é um importante recurso na investigação diagnóstica da COVID-19 e deve ser considerada uma ferramenta útil especialmente em países onde o acesso à tomografia computadorizada está ausente. Além disso, ela pode minimizar o risco de infecção cruzada, pois a superfície da unidade portátil é facilmente higienizada, e pode, ainda mais cedo, reduzir a exposição global à dose de radiação (IPPOLITO et al, 2020;RODRIGUEZ-MORALES et al, 2020).…”