Evaluation of Reliability and Validity of the RALE and BRIXIA Chest-X Ray Scores in Patients Hospitalized with COVID-19 Pneumonia

Abstract

Introduction: Chest X-rays are commonly used to assess the severity in patients that present in the emergency department with suspected COVID-19 pneumonia, but in clinical practice quantitative scales are rarely employed. Aims: To evaluate the reliability and validity of two semi-quantitative radiological scales in patients hospitalized for COVID-19 pneumonia (BRIXIA score and RALE score). Methods: Patients hospitalized between October 2021 and March 2022 with confirmed COVID-19 pneumonia diagnosis were eligible for inclusion. All included patients had a chest X-ray taken in the ED before admission. Three raters that participated in the treatment and management of patients with COVID-19 during the pandemic independently assessed chest X-rays. Results: Intraclass coefficients for BRIXΙA and RALES was 0.781 (0.729-0.826) and 0.825 (0.781-0.862) respectively, showing good to excellent reliability overall. Pairwise analysis was performed using quadratic weighted kappa showing significant variability in the inter-rater agreement. The prognostic accuracy of the two scores for in-hospital mortality for all raters was between 0.753 and 0.763 for BRIXIA and 0.737 and 0.790 for RALES, demonstrating good to excellent prognostic value. Both radiological scores were significantly associated with inhospital mortality after adjustment for 4C Mortality score. We found a consistent upwards trend with significant differences between severity groups in both radiological scores. Conclusion: Our findings suggest that BRIXIA and RALES are reliable and can be used to assess the prognosis of patients with COVID-19 requiring hospitalization. However, the inherent subjectivity of radiological scores might make it difficult to set a cut-off value suitable for all assessors.

Performance of chest X-ray scoring in predicting disease severity and outcomes of patients hospitalised with COVID-19 in Bangladesh

“…The prognostic accuracy of the two scores for in-hospital mortality for all raters demonstrated good to excellent prognostic value having a consistent upward trend with significant differences between severity groups in both radiological scores. 12 At the same time, the number of chest CT requests in this pandemic has been reduced due to hassle in the subsequent necessity for intense infection control measures in CT suites as well as difficulties in mobilizing hypoxic patients, and the involvement of high radiation. 24 , 25 Depending on the extent of involvement by consolidation or GGOs in CXR, we considered a maximum score of 8 in our setting.…”

“… 4 , 8 Till now, several severity scoring systems in CXR have been used for quantitative and objective estimation of lung involvement and progression 10 and some evaluated the area of lung involved, while others focused on infiltrative patterns. 10 , 11 Paraskevas et al 12 suggested two scores, BRIXIA and radiographic assessment of lung edema score (RALES), which are reliable and can be used to assess the prognosis of patients with COVID-19 requiring hospitalisation.…”