Sonia Samat, n/a
medical student
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Kendrah Osei, n/a
MD
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Nikhil Gowda, n/a
Medical student
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Ivy Benjenk, RN, MPH, PhD
Research Coordinator
George Washington University Hospital, United States
Disclosure information not submitted.
Madeline Dorr, n/a
public health student
George Washington University Milken School of Public Health, United States
Disclosure information not submitted.
David Yamane, BS, MD
Assistant Professor of Emergency Medicine, Anesthesiology, and Critical Care Medicine
George Washington University Hospital, United States
Disclosure information not submitted.
Mustafa Al-mashat, MD
Assistant professor
George Washington University, United States
Disclosure information not submitted.
Title: Imaging Findings in COVID-19: Relationship Between Initial Chest Imaging, ICU Admission & Mortality
INTRODUCTION/HYPOTHESIS:
The novel SARS-CoV2 virus, commonly known as COVID-19, was declared a pandemic by the World Health Organization in March 2020. COVID-19 causes a wide spectrum of clinical conditions, ranging from mild to the life-threatening acute respiratory distress syndrome. Many patients initially present with respiratory symptoms and receive chest imaging upon admission. The purpose of this study is to determine whether there is an association between initial chest imaging findings and ICU admission and/or mortality in COVID-19 positive patients.
Methods:
A retrospective chart review of COVID-19 positive inpatients at a tertiary care facility between March 1, 2020, and May 31, 2020 was conducted. Initial chest imaging reports from week one of admission were reviewed for keywords. EMR was reviewed for data on ICU admission and mortality. Mann-Whitney U, Fisher's exact, and chi-squared tests were applied to identify statistically significant associations.
Results:
365 patients were included in this study. The plurality (29.6%) of patients were 50-64 years of age. During the first week of admission, 335/365 (91.78%) patients received a chest radiograph. Abnormalities were present on 273/335 (81.49%) chest radiographs. Opacities were the most frequent abnormality (62.39%), typically in a bilateral distribution (53.43%). A statistically significant association was found between the presence of diffuse (P< 0.001) or bilateral (P< 0.007) opacities; pleural effusion (P< 0.031); and underlying pulmonary conditions (P< 0.048) on initial chest radiographs and mortality. Furthermore, diffuse opacities (P< 0.004) and bilateral opacities (P< 0.041) were associated with ICU admission.
Conclusion:
Our results identify initial chest imaging findings that may portend poor prognosis. Patients with diffuse or bilateral opacities, or pleural effusion on initial imaging should be considered high risk for ICU admission and mortality. Underlying pulmonary pathology present on initial imaging increases risk of ICU admission and mortality, confirming findings established by prior research. Initial radiographic findings can be used to stratify patients at increased risk for mortality and efficiently allocate hospital resources.