SPECTRUM OF CHEST X-RAY FINDINGS IN COVID-19 POSITIVE PATIENTS UTILIZING MODIFIED RALE SCORE FOR SEVERITY ASSESSMENT

Abstract

Objective: To assess chest x-ray appearance of patients with positive RT-PCR test for SARS-Cov-2 and utilize modified RALE score for severity assessment of chest x-ray findings for correlation with clinical spectrum of disease.

Study Design: Prospective observational study.

Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital, Rawalpindi, from Apr 2020 to May 2020. Methodology: First 1000 consecutive chest x-rays of COVID-19 patients with RT-PCR confirmation at our setup were analyzed. Positive chest x-rays were assessed for consolidation, ground glass opacities and location of involvement. A severity index using modified RALE score was calculated for each & both lungs.

Results: 932 patients were males and 68 were females with an average age of 40.77 years ± 13.58. Out of 1000 patients, 759 (75.9%) had normal chest x-rays. 241 patients had positive findings, ground glass opacities being the most frequent feature 211 (87.6%) showing peripheral 219 (90.9%), bilateral 182 (75.5%) and lower zone predominance 221 (91.7%). The optimal modified RALE score threshold for recognizing severe disease was 4.5 (area under curve, 0.943), with 79.2% sensitivity and 96.3% specificity.

Conclusion: COVID-19 patients with positive chest x-ray findings frequently showed ground glass opacities with bilateral lower zone involvement in peripheral distribution. Modified RALE score can be used for objective evaluation of clinically severe patients.