Chest X-Ray Findings in 636 Pts with COVID-19 Presenting to an Urgent Care Center: A Normal Chest X-Ray is no Guarantee

https://www.jucm.com/documents/jucm-covid-19-studyepub-april-2020.pdf/

Retrospective observational study determining % of nl vs abnl CXRs in pts visiting urgent care (UC) with #COVID19

#COVID19FOAM

Reviewed database of >100 UC centers in NYC and NJ

CXRs divided & read amongst 11 radiologists

All films were re-read to confirm findings

636 CXRs reviewed
Normal CXR = 371 (58.3%)
Abnormal CXR = 265 (41.7%)
Mild Dz = 195 (30.7%)
Moderate Dz = 65 (10.2%)
Severe Dz = 5 (0.8%)

Predominant findings:
Interstitial changes = 151 (23.7%)
Ground glass opacities (GGOs) = 120 (18.9%)
Lower lobe location = 215 (33.8%)
Bilateral location = 133 (20.9%)
Multifocal = 154 (24.2%)
Effusions and Lymphadenopathy were uncommon

1st/largest study to evaluate CXRs in pts with COVID19 in UC setting

468/636 (73.6%) of CXRs were initially read as nl
When asked to re-read CXR with knowledge that pts had COVID19, 97 of initial readings were changed to abnl

Nl or Mildly Abnl CXR = 566/636 (89%) despite sxs

Chest Guidelines recommend against routine use of imaging in pts with suspected COVID19 and mild clinical features unless they are at risk for dz progression

https://journal.chestnet.org/article/S0012-3692(20)30673-5/fulltext