Utility of chest radiograph severity scoring in emergency department for predicting outcomes in COVID-19: A study of 1275 patients.

OBJECTIVE: To measure the reliability and reproducibility of a chest radiograph severity score (CSS) in prognosticating patient's severity of disease and outcomes at the time of disease presentation in the emergency department (ED) with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: We retrospectively studied 1275 consecutive RT-PCR confirmed COVID-19 adult patients presenting to ED from March 2020 through June 2020. Chest radiograph severity score was assessed for each patient by two blinded radiologists. Clinical and laboratory parameters were collected. The rate of admission to intensive care unit, mechanical ventilation or death up to 60 days after the baseline chest radiograph were collected. Primary outcome was defined as occurrence of ICU admission or death. Multivariate logistic regression was performed to evaluate the relationship between clinical parameters, chest radiograph severity score, and primary outcome. RESULTS: CSS of 3 or more was associated with ICU admission (78 % sensitivity; 73.1 % specificity; area under curve 0.81). CSS and pre-existing diabetes were independent predictors of primary outcome (odds ratio, 7; 95 % CI: 3.87, 11.73; p < 0.001 & odds ratio, 2; 95 % CI: 1-3.4, p 0.02 respectively). No significant difference in primary outcome was observed for those with history of hypertension, asthma, chronic kidney disease or coronary artery disease. CONCLUSION: Semi-quantitative assessment of CSS at the time of disease presentation in the ED predicted outcomes in adults of all age with COVID-19.

Effect of technologist and patient attributes on centering for body CT examinations: Influence of cultural and ethnic factors.

There are no published data on the effect of patient and technologist gender and ethnicity attributes on off-centering in CT. Therefore, we assessed the impact of patient and technologist variations on off-centering patients undergoing body CT. With institutional review board approval, our retrospective study included 1000 consecutive adult patients (age ranged 22-96 years; 756 males: 244 females) who underwent chest or abdomen CT examinations. We recorded patient (age, gender, nationality, body weight, height,), technologist gender, and scan-related (scanner vendor, body region imaged, scan length, CT dose index volume, dose length product) information. Lateral and anteroposterior (AP) diameters were recorded to calculate effective diameter and size-specific dose estimate (SSDE). Off-centering represented the distance between the anterior-posterior centers of the scan field of view and the patient at the level of carina (for chest CT) and iliac crest (for abdomen CT). About 76% of the patients (760/1000) were off-centered with greater off-centering for chest (22 mm) than for abdomen (15 mm). Although ethnicity or patient gender was not a significant determinant of off-centering, technologist-patient gender mismatch was associated with a significantly greater frequency of off-centering (p<0.001). Off-centering below the gantry isocenter was twice as common as off-centering above the gantry isocenter (p<0.001). The latter occurred more frequently in larger patients and was associated with higher radiation doses than those centered below the isocenter (p<0.001). Technologists' years of experience and patient factors profoundly affect the presence and extent of off-centering for both chest and abdomen CTs. Larger patients are more often off-centered than smaller patients.