triage pulse oximetry and the chest x -ray opacity score

• Coronavirus disease 2019 (COVID-19) was first documented in December of 2019. It is highly contagious and in March of 2020 the World Health Organization declared the outbreak as a pandemic due to its rapid global spread. • Plain radiograph is often used in the initial evaluation of chest pain and dyspnea. It can be done portably. Additionally, it is widely available, inexpensive, and quick. • The initially CXR in combination with vital signs and clinical assessment often guide important decision for patient care such as admission and intubation. BACKGROUND RESULTS • Interrater reliability was low in our study. Future studies can compare scores of radiologist with ED physicians. DISCUSSION CONCLUSIONS Triage Pulse Oximetry and the Chest X-ray Opacity Score in ED Patients with COVID-19 Pneumonia Sushi Subburamu MD*, Eryka Bradley PA, Ruchika Darapaneni, Kewa Jiang, Robert Lis, Niloofar Sima, Denise McCormack MD, MPH* North Bronx Healthcare Network, Jacobi Medical Center and North Central Bronx Hospital Albert Einstein College of Medicine* METHODS • In COVID-19 pneumonia there was weak correlation between triage hypoxia and pneumonia severity based on the CXR opacity score. • Increased mortality was associated with older age, hypertension, dialysis, triage PO ≤ 85%, need for intubation, and CXR score ≥ 3. • A retrospective chart review was conducted for patients seen in April 2020. • Inclusion criteria consisted of adult ED patients who were admitted with COVID-19 pneumonia. • Demographic information, Emergency Severity Index (ESI), triage PO, Body Mass Index (BMI), comorbidities and intubation rates were analyzed using chi-square and student's t-test. • An EM attending and senior EM resident determined the CXR opacity scores in severity ranging from 0 to 6. A kappa score was generated to assess interrater agreement. • A linear regression model was done to assess the correlation between triage PO and CXR scores. • The primary outcome was mortality. REFERENCES Wasilewski P, Mruk B, Mazur S, et al. COVID-19 severity scoring systems in radiological imaging – a review. Pol J Radiol. 2020; 85:e361–e368. Toussie D, Voutsinas N, Finkelstein M, et al. Clinical and chest radiography features determine patient outcomes in young and middle-aged adults with COVID-19. Radiology. 2020; 297(1):e197-e206 THE CXR SCORE • Various ways of scoring an CXR have been proposed dividing the lungs into either 4 or 6 sections. • In our study each lung was divided into 3 zones as marked above. The top line is marked below the inferior wall of the aortic arch and the bottom line is marked below the right hilar structures. • Each zone is then given a score of 0 or 1 based on whether opacities are present. CXR score range from 0-6. • 306 patients met inclusion criteria • Mortality was 21% • 40.2% of patients were male • Most patients were triaged as ESI 2 (36.3%) or ESI 3 (60.7%). • The mean age was 61.9 ± 14.7 years • The mean BMI was 30.1 ± 6.4 • The mean triage PO was 88.7 ± 3.9. • Pneumonia on CXR was 85.3% bilateral, 6.5% left and 8.2% right. 43.5% of patients were given CXR opacity scores ≥ 3. • The kappa score for CXR score agreement was 0.47. • The mortality group was associated with: • Older age (70.9 ± 11.3 vs 59.3 ± 14.6; P<0.01) • Hypertension (66.7% vs 49.2%; P <0.05) • Dialysis (12.7% vs 4.5%; P <0.05) • CXR score ≥ 3 (84.8% vs 62.5%; P <0.05) • Triage PO ≤ 85% (48.4% vs 21.9%; P<0.01) • Intubation (35.9% vs 10.3%; P<0.01) • Smoking, BMI, asthma and diabetes were not associated with mortality. • The R 2 correlation coefficient for triage PO and the CXR opacity score was 0.12. RESULTS (cont.)

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Page 1: Triage Pulse Oximetry and the Chest X -ray Opacity Score

• Coronavirusdisease2019(COVID-19)wasfirstdocumentedinDecemberof2019.ItishighlycontagiousandinMarchof2020theWorldHealthOrganizationdeclaredtheoutbreakasapandemicduetoitsrapidglobalspread.

• Plainradiographisoftenusedintheinitialevaluationofchestpainanddyspnea.Itcanbedoneportably.Additionally,itiswidelyavailable,inexpensive,andquick.

• The initiallyCXRincombinationwithvitalsignsandclinicalassessmentoftenguideimportantdecisionforpatientcaresuchasadmissionandintubation.

BACKGROUND

RESULTS

• Interraterreliabilitywaslowinourstudy.FuturestudiescancomparescoresofradiologistwithEDphysicians.

DISCUSSION

CONCLUSIONS

TriagePulseOximetryandtheChestX-rayOpacityScoreinEDPatientswithCOVID-19Pneumonia

Sushi Subburamu MD*, Eryka Bradley PA, Ruchika Darapaneni, Kewa Jiang, Robert Lis, Niloofar Sima, Denise McCormack MD, MPH*

North Bronx Healthcare Network, Jacobi Medical Center and North Central Bronx Hospital Albert Einstein College of Medicine*

METHODS• In COVID-19pneumoniatherewasweak

correlationbetweentriagehypoxiaandpneumoniaseveritybasedontheCXRopacityscore.

• Increasedmortalitywasassociatedwitholderage,hypertension,dialysis,triagePO≤85%,needforintubation,andCXRscore≥3.

• A retrospectivechartreviewwasconductedforpatientsseeninApril2020.

• InclusioncriteriaconsistedofadultEDpatientswhowereadmittedwithCOVID-19pneumonia.

• Demographicinformation,EmergencySeverityIndex(ESI),triagePO,BodyMassIndex(BMI),comorbiditiesandintubationrateswereanalyzedusingchi-squareandstudent'st-test.

• AnEMattendingandseniorEMresidentdeterminedtheCXRopacityscoresinseverityrangingfrom0to6.Akappascorewasgeneratedtoassessinterrateragreement.

• AlinearregressionmodelwasdonetoassessthecorrelationbetweentriagePOandCXRscores.

• Theprimaryoutcomewasmortality.

REFERENCESWasilewski P, Mruk B, Mazur S, et al. COVID-19 severity scoring systems in radiological imaging – a review. Pol J Radiol. 2020; 85:e361–e368.

Toussie D, Voutsinas N, Finkelstein M, et al. Clinical and chest radiography features determine patient outcomes in young and middle-aged adults with COVID-19. Radiology. 2020; 297(1):e197-e206

THE CXR SCORE

• VariouswaysofscoringanCXRhavebeenproposeddividingthelungsintoeither4or6sections.

• Inourstudyeachlungwasdividedinto3zonesasmarkedabove.Thetoplineismarkedbelowtheinferiorwalloftheaorticarchandthebottomlineismarkedbelowtherighthilarstructures.

• Eachzoneisthengivenascoreof0or1basedonwhetheropacitiesarepresent.CXRscorerangefrom0-6.

• 306patientsmetinclusioncriteria• Mortalitywas21%• 40.2%ofpatientsweremale• MostpatientsweretriagedasESI2(36.3%)orESI3(60.7%).• Themeanagewas61.9± 14.7years• ThemeanBMIwas30.1± 6.4• ThemeantriagePOwas88.7± 3.9.• PneumoniaonCXRwas85.3%bilateral,6.5%leftand8.2%right.

43.5%ofpatientsweregivenCXRopacityscores≥3.• ThekappascoreforCXRscoreagreementwas0.47.

• Themortalitygroupwasassociatedwith:• Olderage(70.9± 11.3vs59.3± 14.6;P<0.01)• Hypertension(66.7%vs49.2%;P<0.05)• Dialysis(12.7%vs4.5%;P<0.05)• CXRscore≥3(84.8%vs62.5%;P<0.05)• TriagePO≤85%(48.4%vs21.9%;P<0.01)• Intubation(35.9%vs10.3%;P<0.01)

• Smoking,BMI,asthmaanddiabeteswerenotassociatedwithmortality.

• TheR2 correlationcoefficientfortriagePOandtheCXRopacityscorewas0.12.

RESULTS (cont.)

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