Original Research

Chest radiography evaluation in patients admitted with confirmed COVID-19 infection, in a resource limited South African isolation hospital

Sereesh Moodley, Tanusha Sewchuran
South African Journal of Radiology | Vol 26, No 1 | a2262 | DOI: https://doi.org/10.4102/sajr.v26i1.2262 | © 2022 Sereesh Moodley, Tanusha Sewchuran | This work is licensed under CC Attribution 4.0
Submitted: 01 August 2021 | Published: 17 January 2022

About the author(s)

Sereesh Moodley, Department of Radiology, School of Clinical Medicine, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
Tanusha Sewchuran, Department of Radiology, School of Clinical Medicine, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa


Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent global outbreak (coronavirus disease 2019 [COVID-19]) was declared a public health emergency in January 2020. Recent radiologic literature regarding COVID-19 has primarily focused on Computed Tomography (CT) chest findings, with chest radiography lacking in comparison.

Objectives: To describe the demographic profile of adult patients with COVID-19 pneumonia requiring hospital admission. To describe and quantify the imaging spectrum on chest radiography using a severity index, and to correlate the severity of disease with prognosis.

Method: Retrospective review of chest radiographs and laboratory records in patients admitted to a South African tertiary hospital with confirmed COVID-19 infection. The chest X-rays were systematically reviewed for several radiographic features, which were then quantified using the Brixia scoring system, and correlated to the patient’s outcome.

Results: A total of 175 patients (mean age: 53.34 years) admitted with COVID-19 were included. Ground glass opacification (98.9%), consolidation (86.3%), and pleural effusion (29.1%) was commonly found. Involvement of bilateral lung fields (96.6%) with no zonal predominance (61.7%), was most prevalent. Correlation between the Brixia score and outcome was found between severe disease and death (odds ratio [OR]: 12.86; 95% confidence interval [CI]: 1.58–104.61). Many patients had unknown TB (71.4%) and HIV (72.6%) statuses.

Conclusion: In this study population, ground glass opacification, consolidation, and pleural effusions, with bilateral lung involvement and no zonal predominance were the most prevalent findings in proven COVID-19 infection. Quantification using the Brixia scoring system may assist with timeous assessment of disease severity in COVID-19 positive patients, as an overall predicator of clinical outcome.


chest radiography; chest X-ray; SARS-CoV-2; COVID-19; chest X-ray scoring system; Brixia scoring system; resource limited setting; South Africa


Total abstract views: 3000
Total article views: 2792


Crossref Citations

1. Brixia and qSOFA Scores, Coagulation Factors and Blood Values in Spring versus Autumn 2021 Infection in Pregnant Critical COVID-19 Patients: A Preliminary Study
Catalina Filip, Roxana Covali, Demetra Socolov, Mona Akad, Alexandru Carauleanu, Ingrid Andrada Vasilache, Ioana Sadiye Scripcariu, Ioana Pavaleanu, Tudor Butureanu, Madalina Ciuhodaru, Lucian Vasile Boiculese, Razvan Socolov
Healthcare  vol: 10  issue: 8  first page: 1423  year: 2022  
doi: 10.3390/healthcare10081423