1889. Chest Radiograph Severity Scoring “Sextus Score” Correlates to Clinical Outcomes in Patients with COVID-19
Authors * Denotes Presenting Author
  1. Justin Sun *; Temple University Lewis Katz School of Medicine
  2. Kevin Yoo; Temple University Lewis Katz School of Medicine
  3. Robert Choi; Temple University Lewis Katz School of Medicine
  4. Maruti Kumaran; Temple University Health Systems
  5. Omar Agosto; Temple University Health Systems
  6. Gary Cohen; Temple University Health Systems
  7. Hillel Maresky; Temple University Health Systems
Although chest radiography (CXR) has been widely employed in the initial detection of abnormalities and in monitoring disease evolution of coronavirus disease-2019 (COVID-19) patients, its value in detection and as an outcome predictor in the management of patients with COVID-19 has not been fully understood.1–6 Our study assesses the prognostic value of CXR using a standardized scoring system in hospitalized patients found to be COVID-19 positive by imaging criteria and to compare its value to that of computed tomography (CT).7–9

Materials and Methods:
In this cross-sectional study, patients aged 18 years or older who underwent chest CT at a single institution with an imaging-based diagnosis of COVID-19 between 3/15/20-4/16/20 were included. Each patient’s CXR and coronal CT were analyzed for opacities in a six-zonal assessment method and aggregated into a “Sextus Score.” Each lung was divided into three zones and each assigned a binary score based on the absence (0) or presence (1) of opacities at least 1 cm2 in size. The points of each lung zone were summed (score 0-6). Univariable and multiple logistic regression techniques were used to investigate the relationships between CXR scores and clinical parameters in relation to patient outcomes.

124 patients (median [IQR] age 58.5 [47.5-69.0] years, 72 (58%) men, 58 (47%) Blacks and 35 (28%) Hispanics) were included. The CXR Sextus Score (range: 0-6) was reliable (inter-rater kappa=0.76; 95% CI: 0.69-0.83) and correlated strongly with the CT Sextus Score (Spearman correlation coefficient=0.75, p<0.0001). Higher CXR Sextus Scores of 2 points were found to be an independent predictor of intubation (adjusted Odds Ratio (aOR) (95% CI): 4.49 (1.98, 10.20), p=0.0003) and prolonged hospitalization (=10 days) (aOR (95% CI): 4.06 (1.98, 8.32), p=0.0001). In univariable analysis, incrementally increasing CXR Sextus Score by 2 points was found to be significantly associated with mortality (odds ratio (OR): 2.31, 95% CI 1.01-5.29, p=0.048).

Plain film acquisition (CXR) lends itself to directing patient care in real time and greater accessibility. The tight inter-reader agreement of CXR Sextus Scores and strongly correlated CXR-CT Sextus Scores make the Sextus Score an objective and reproducible system. A CXR Sextus Score may also confer added value as a potential prognosticator as higher CXR Sextus Scores were associated with higher mortality; likewise, Sextus Score proved itself as an independent predictor of intubation and prolonged hospitalization (= 10 days) especially when scores were =3 points. As there are still no definitive consensus guidelines for comprehensive COVID-19 thoracic imaging, our team found that the combination of a single chest CT upon presentation followed by serial CXRs may provide clinicians with crucial insight regarding patients who are at higher risk for requiring intubation independent of other clinical factors. Additional research may demonstrate the true potential of the Sextus Score to assist not only with triage but also in monitoring of the COVID-19 disease course in hospitalized patients.