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1568. Coronavirus Disease: Value of Chest Radiography for Older Patients at an Earlier Timepoint of Symptoms Compared with Younger Patients
Authors * Denotes Presenting Author
  1. Mae Igi *; Lousiana State University Health Sciences Center
  2. Joe Park; Lousiana State University Health Sciences Center
  3. Molly Lieux; Lousiana State University Health Sciences Center
  4. Catherine Batte; Louisiana State University College of Science
  5. Bradley Spieler; Lousiana State University Health Sciences Center
Objective:
Compared with chest computed tomography (CT), there is a relative paucity of data regarding the role of chest radiography (CXR) in the diagnosis of COVID-19; in this paper we address the utility of using a strict pattern of findings at CXR for the diagnosis of COVID-19 particularly during early onset of symptoms in patients above and below the age of 50.

Materials and Methods:
A retrospective study was performed of patients under investigation for COVID-19 presenting to the emergency room during the growth phase of the COVID-19 outbreak in March 2020 at our institution who had a CXR within one week of reported symptoms per the Electronic Medical Record (EMR). Two board certified radiologists, blinded to RT-PCR results, assessed 60 CXRs in consensus and assigned one of three patterns: Characteristic, Nonspecific, and Negative utilizing well-documented COVID-19 imaging patterns. The Nonspecific patterns were further divided into more suspicious or less suspicious of COVID-19.

Results:
60 patients were included, 30 in both the age >50 cohort and age ? 50 cohort. The range of ages in the > 50 group was 52-88. The range in the younger group was 19-48. (93%) of the older group demonstrated an abnormal CXR early in the course of disease. Only 7% of patients in the older group had a negative CXR within the first week of presentation from symptom onset. In contrast to the early manifestations of COVID infection on imaging in the older group, the younger comparison group exhibited abnormal CXR in this early time course of illness in only 53% of patients. The other 47% of younger patients demonstrated normal CXR. The relationship between age and CXR findings were determined to be statistically significant with a ?2 (2, n=60) = 15.70, p = .00039. Also, a Fisher Exact test was performed comparing negative and characteristic COVID CXR findings to patient age, and the relationship was found to be statistically significant with a Fisher Exact Test statistic value = 0.001, p <0.05.

Conclusion:
COVID-19 positive patients > age 50 show earlier, more specific patterns of statistically significant CXR changes than younger patients, suggesting that CXR is useful in the early diagnosis of infection.