Yoğun bakım ihtiyacı olan COVID-19 hastalarını ayırt etmede akciğer grafisinin performansının değerlendirilmesi

Abstract

Amaç: COVID-19 hastalarından yoğun bakım ünitesi (YBÜ) ihtiyacı olanları ayırt etmede akciğer grafisinin performansının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Nisan ve Ağustos 2020 tarihleri arasında, hastaneye yatırılan ve 24 saat içinde akciğer grafisi elde olunan ardışık 166 COVID-19 hastası çalışmaya dahil edildi. Tüm hastaların yaş, cinsiyet, eşlik eden hastalık, sigara içme durumu ve semptom süresi kaydedildi. Birinci gözlemci tüm hastaların akciğer grafilerinde radyolojik bulguları değerlendirdi. Radyografik bulguların dağılımı not edildi. Daha sonra iki gözlemci birbirinden bağımsız olarak tüm akciğer grafilerine akciğer ödemi radyografik değerlendirme (AÖRD) skoru verdi. Her iki gözlemci için COVID-19 hastalarından YBÜ ihtiyacı olanları belirlemede duyarlılık ve özgüllük değerleri hesaplandı. Intraclass Correlation Coefficient (ICC) testi gözlemciler arası uyumluluğu değerlendirmek için kullanıldı. Bulgular: Hastaların 128’i (%77.1) sadece hastaneye yatırılırken, 38’i (%22.9) YBÜ’ne ihtiyaç duydu. AÖRD skoru için 7.5 eşik değeri olarak kullanıldığında YBÜ gereksinimi olan COVID-19 hastalarını ayırt etmede birinci gözlemci için %89.5 ve %93 duyarlılık ve özgüllük değerleri; ikinci gözlemci için %89.5 ve %91.4 duyarlılık ve özgüllük değerleri bulundu. Gözlemciler arası uyumluluk için ICC değeri 0.988 (%95 güven aralığı: 0.983 – 0.991) olarak bulundu. Sonuç: Akciğer grafisi YBÜ ihtiyacı olan COVID-19 hastalarını belirlemede yardımcı olabilir ve 7.5’ten büyük AÖRD skoru YBÜ gereksinimini gösterir.

Keywords

• COVID-19
• AKCİĞER GRAFİSİ
• YOĞUN BAKIM ÜNİTESİ

Evaluation of performance of chest x-ray in distinguishing intensıve care unit need among COVID-19 patients

Abstract

Aim: To investigate the performance of chest X-ray (CXR) in distinguishing the patients who necessitate intensive care unit (ICU) admission among COVID-19 patients. Material and Methods: Between April to August 2020, 166 consecutive hospitalized COVID-19 patients who underwent acquisition of CXR within 24 hours of hospital admission were included in the study. Age, gender, number of comorbidities, smoking status and duration of symptoms for all patients were noted. Observer 1 interpreted the radiographic findings of CXRs of all patients. Distribution of radiographic findings were noted. Afterwards, Observer 1 and observer 2 assigned radiographic assessment of lung edema (RALE) score for each CXR independently. Sensitivity, specificity values in distinguishing COVID-19 patients who require ICU for each observer were calculated. Intraclass Correlation Coefficient (ICC) test was used to assess interobserver agreement levels. Results: Of the included patients, 128 (77.1%) patients were hospitalized only whereas 38 (22.9%) patients had necessity for ICU admission. Using 7.5 for RALE score as a cut-off point in distinguishing COVID-19 patients who need ICU admission Observer 1 had 89.5% and 93% for sensitivity and specificity, respectively; and Observer 2 had 89.5% and 91.4% for sensitivity and specificity, respectively. The ICC value for the interobserver agreement in RALE scores was 0.988 (95% confidence interval: 0.983 – 0.991). Conclusion: CXR can be helpful in distinguishing COVID-19 patients who necessitates ICU admission and a RALE score higher than 7.5 is indicative for ICU requirement.

Keywords

• COVID-19
• CHEST X-RAY
• INTENSIVE CARE UNIT

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