ABSTRACT
OBJECTIVE: In the present study, we evaluated the role of portable chest radiographs in critically ill patients with COVID-19 pneumonia in whom computed tomography (CT) of the chest was not feasible. METHODS: A retrospective chest X-ray study of patients under investigation for COVID-19 was performed in our dedicated COVID hospital (DCH) during the exponential growth phase of the COVID-19 outbreak (August-October, 2020). A total of 562 on-bed chest radiographs were examined comprising 289 patients (critically ill who couldn't be mobilized for CT) along with positive reverse transcription-polymerase chain reaction (RT-PCR) tests. We categorized each chest radiograph as progressive, with changes, or improvement in appearance for COVID-19, utilizing well-documented COVID-19 imaging patterns. RESULTS: In our study, portable radiographs provided optimum image quality for diagnosing pneumonia, in critically ill patients. Although less informative than CT, nevertheless radiographs detected serious complications like pneumothorax or lung cavitation and estimated the evolution of pneumonia. CONCLUSION: A portable chest X-ray is a simple but reliable alternative for critically ill SARS-CoV-2 patients who could not undergo chest CT. With the help of portable chest radiographs, we could monitor the severity of the disease as well as different complications with minimal radiation exposure which would help in identifying the prognosis of the patient and thus help in medical management.
ABSTRACT
Background: Cardiac signs can show illness progression and severity in a number of respiratory and cardiovascular disorders. The possible importance of CT findings in the prognosis and result of COVID-19 patients is related to the severity of lung disease and cardiac parameters. The CT-assessed cardiac indices are known for predicting the involvement of extent of diseases. Hence, the objective of this study was to correlate the extent of cardiovascular and respiratory involvement in predicting the severity of disease using CT-assessed cardiac indices in Indian population suffering from COVID-19. Methodology: A total of 120 COVID-19 patients were included following the inclusion criteria for one year. The confounding factors were assessed and analyzed. The correlation between the cumulative hazard function of death and duration in hospital along with survival rate were done in terms of pulmonary artery-to-aorta ratio (PA/A), and cardiothoracic ratio (CTR). Results: The analysis showed mean age of patients to be 49.5(±15.32) years in which mean females were 38(±31.7) and males were 82(±68.3). The interquartile range of CT severity was 8. The PA/A ratio in discharged patients was 0.85 when compared to deceased patients with 1.03 having statistically significant inference (P = 0.00). The CTR (P = 0.00), epicardial adipose thickness (P = 0.00), epicardial adipose density (P = 0.00), and D-dimer (P = 0.007) were showing statistically significant inference. Conclusion: The predictive values of CT-assessed cardiac indices might be used for predicting the involvement of cardiovascular and respiratory involvement in COVID-19 patients. It could have an impact on improving the possibilities of survival of patients suffering from COVID-19 in India.
ABSTRACT
BACKGROUND: Chest CT scans are done in cases of coronavirus disease 2019 (COVID-19)-positive patients to understand the severity of the disease and plan treatment accordingly. Severity is determined according to a 25-point scoring system, however, there could be interobserver variability in using this scoring system thus leading to the different categorization of patients. We tried to look for this interobserver variability and thus find out its reliability. METHODS: The study was retrospective and was done in a designated COVID center. Some 100 patients were involved in the study who tested positive for COVID-19 disease. The research was conducted over six months (January 2021 to June 2021). Images were given to three radiologists with a minimum of 10 years of experience in thoracic imaging working in different setups at different places for interpretation and scoring further and their scores were compared. Before the study, the local ethics committee granted its approval. RESULTS: There was no significant variability in the interobserver scoring system thus proving its reliability. The standard deviation between different observers was less than three. There was almost perfect agreement amongst all the observers (Fleiss' K=0.99 [95% confidence interval, CI: 0.995-0.998]). Maximum variations were observed in the moderate class. Conclusion: There was minimum inter-observer variability in the 25-point scoring system thus proving its reliability in categorizing patients according to severity. There was no change in the class of the patient according to its severity. A 25-point scoring system hence can be used by clinicians to plan treatment and thus improve a patient's prognosis.