ARRS 2022 Abstracts

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ERS2320. Systematic Review and Meta-Analysis of Chest Radiograph (CXR) Findings in COVID-19
Authors * Denotes Presenting Author
  1. Zuhair Sadiq *; Weill Cornell Medicine
  2. Shehroz Rana; Weill Cornell Medicine
  3. Ziyad Mahfoud; Weill Cornell Medicine
  4. Ameed Raoof; Weill Cornell Medicine
Objective:
In COVID-19, CXR imaging can play a role in triaging patients due to long PCR turnaround times. It has several advantages over CT such as cost and practical considerations, which limits CT's utility. As such, CXR is a useful modality for identification of COVID-19 and follow-up of any associated lung abnormalities. This review provides a meta-analysis of the current literature on CXR imaging findings to determine the most common appearances of lung abnormalities in COVID-19 patients in order to equip medical researchers and healthcare professionals in their efforts to combat this pandemic.

Materials and Methods:
Twelve studies met the inclusion criteria and were analyzed. The inclusion criteria consisted of: (1) published in English literature; (2) original research study; (3) sample size of at least 5 patients; (4) reporting clinical characteristics of COVID-19 patients as well as CXR imaging features; and (5) noting the number of patients with each corresponding imaging feature. A total of 1948 patients were included in this study. To perform the meta-analysis, a random-effects model calculated the pooled prevalence and 95% confidence intervals of abnormal CXR imaging findings.

Results:
Chest radiographs may be found to be “normal” in early or mild disease, however, COVID-19 patients can later develop radiological or clinical signs of viral pneumonia. Seventy-four percent (74%) (95% CI: 51–92%) of patients with COVID-19 had an abnormal CXR at the initial time of diagnosis or sometime during the disease course. Although the number of participants covered by individual COVID-19 CXR studies is low when compared to similarly designed CT studies, a characteristic set of findings are clear. There is no single feature on CXR that is diagnostic of COVID-19 viral pneumonia. Our findings are consistent with meta-analyses of pertinent COVID-19 features on chest CT, which suggest that the disease presents as atypical or organizing pneumonia on imaging. The most common abnormalities are consolidation (28%, 95% CI: 8–54%) and ground-glass opacities (29%, 95% CI: 10–53%). The distribution is most frequently bilateral (43%, 95% CI: 27–60%), peripheral (51%, 95% CI: 36–66%), and basal zone (56%, 95% CI: 37–74%) predominant. In contrast to parenchymal abnormalities, pneumothorax (1%, 95% CI: 0–3%) and pleural effusions (6%, 95% CI: 1–16%) are rare.

Conclusion:
Our results confirm that CXR will continue to be a useful tool in the evaluation and management of patients diagnosed with COVID-19. Although less sensitive than chest CT, CXR can prove useful in its prognostic predictions such as triaging patients and answering questions in regards to whether a patient should stay home, if they will need the ICU in a few days, if they will respond to a specific treatment such as intubation or some drug, whether they should be taken off a ventilator and their overall chances for survival. With an ever-growing number of suspected cases in this pandemic, CXR should be seen as a quick and easy-to-use modality to assess lung abnormalities.