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


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Abstract

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.


Keywords

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

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