Chest X-ray Findings and Temporal Changes Among Adult Patients with COVID-19 Admitted in a Tertiary Referral Center

Santos, Julian A.; Cañal, Johanna Patricia A.

PURPOSE: To describe the radiographic findings of hospitalized adult Filipino COVID-19 patients on serial chest x-ray imaging. METHOD: We performed a retrospective review of records and chest x-rays of eligible adult Filipinos with confirmed COVID-19 admitted from 1 March 2020 to 31 July 2020. Demographics, clinical outcomes, and chest radiographic findings were recorded. Serial chest x-ray findings were correlated with the clinical outcome. RESULTS: From 144 adult patients (93 males and 51 females), a total of 785 chest x-rays were reviewed (144 baseline and 641 follow-up). The most common finding overall is ground-glass opacity. The most common distribution pattern is bilateral, patchy/diffuse involvement of the central/peripheral zones. In x-rays taken after the third admission day, reticular opacities become more common than consolidation. The radiographic extent score was higher for deceased patients compared to the survivors at Day 7-9 (6 vs 4.4, p-value = 0.0011), Day 10-12 (5.9 vs 4.3, p-value = 0.0079) and Day 13-15 (5.5 vs 4.1, p-value = 0.0297). The presence of endotracheal tubes (68% vs 7.5%, p-value < 0.001) and pleural effusion (70% vs. 36%, p-value = 0.0004) were higher among the deceased. Reticular opacities were more common for discharged patients (50% vs 30%, p-value = 0.0021). CONCLUSION: Ground-glass opacities with bilateral, patchy/diffuse involvement of the central/peripheral zones are the most common findings. The presence of endotracheal intubation, pleural effusion, and persistently elevated radiographic extent scores are typically seen in deceased patients. Serial chest radiography with radiographic extent scoring is a useful tool in monitoring COVID-19 for hospitalized adult patients.