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Clinical and Chest Radiography Features Determine Patient Outcomes in Young and Middle-aged Adults with COVID-19
- Source :
- Radiology
- Publication Year :
- 2020
- Publisher :
- Radiological Society of North America, 2020.
-
Abstract
- Background Chest radiography has not been validated for its prognostic utility in evaluating patients with coronavirus disease 2019 (COVID-19). Purpose To analyze the prognostic value of a chest radiograph severity scoring system for younger (nonelderly) patients with COVID-19 at initial presentation to the emergency department (ED); outcomes of interest included hospitalization, intubation, prolonged stay, sepsis, and death. Materials and Methods In this retrospective study, patients between the ages of 21 and 50 years who presented to the ED of an urban multicenter health system from March 10 to March 26, 2020, with COVID-19 confirmation on real-time reverse transcriptase polymerase chain reaction were identified. Each patient's ED chest radiograph was divided into six zones and examined for opacities by two cardiothoracic radiologists, and scores were collated into a total concordant lung zone severity score. Clinical and laboratory variables were collected. Multivariable logistic regression was used to evaluate the relationship between clinical parameters, chest radiograph scores, and patient outcomes. Results The study included 338 patients: 210 men (62%), with median age of 39 years (interquartile range, 31-45 years). After adjustment for demographics and comorbidities, independent predictors of hospital admission (n = 145, 43%) were chest radiograph severity score of 2 or more (odds ratio, 6.2; 95% confidence interval [CI]: 3.5, 11; P < .001) and obesity (odds ratio, 2.4 [95% CI: 1.1, 5.4] or morbid obesity). Among patients who were admitted, a chest radiograph score of 3 or more was an independent predictor of intubation (n = 28) (odds ratio, 4.7; 95% CI: 1.8, 13; P = .002) as was hospital site. No significant difference was found in primary outcomes across race and ethnicity or those with a history of tobacco use, asthma, or diabetes mellitus type II. Conclusion For patients aged 21-50 years with coronavirus disease 2019 presenting to the emergency department, a chest radiograph severity score was predictive of risk for hospital admission and intubation. © RSNA, 2020 Online supplemental material is available for this article.
- Subjects :
- Male
Adult
medicine.medical_specialty
medicine.medical_treatment
Pneumonia, Viral
Severity of Illness Index
030218 nuclear medicine & medical imaging
Thoracic Imaging
Young Adult
03 medical and health sciences
Betacoronavirus
0302 clinical medicine
Predictive Value of Tests
Interquartile range
Internal medicine
Severity of illness
Intubation, Intratracheal
medicine
Intubation
Humans
Radiology, Nuclear Medicine and imaging
Lung
Pandemics
Retrospective Studies
Original Research
medicine.diagnostic_test
business.industry
SARS-CoV-2
COVID-19
Retrospective cohort study
Emergency department
Odds ratio
Middle Aged
Prognosis
Hospitalization
Coronavirus
Radiography
Treatment Outcome
030220 oncology & carcinogenesis
Predictive value of tests
Female
Radiography, Thoracic
Tomography, X-Ray Computed
Chest radiograph
business
Coronavirus Infections
Subjects
Details
- Language :
- English
- ISSN :
- 15271315 and 00338419
- Volume :
- 297
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Radiology
- Accession number :
- edsair.doi.dedup.....cabc6d5b16fa1941723f55db1b71b68d