Portable Chest Radiography as an Exclusionary Test for Adverse Clinical Outcomes During the COVID-19 Pandemic

Area of Science:

• Radiology
• Infectious Diseases
• Critical Care Medicine

Background:

• Chest radiography (CXR) is frequently used in acute settings for COVID-19 patients.
• The utility of a negative CXR in predicting outcomes for COVID-19 has not been clearly established.

Purpose of the Study:

• To determine if portable CXR can serve as an effective exclusionary test for adverse clinical outcomes in patients with suspected COVID-19.

Main Methods:

• Retrospective review of adult patients suspected of COVID-19 across five New York City emergency departments.
• Patients were categorized by the absence of findings on initial CXR.
• Primary outcomes included hospital admission, mechanical ventilation, ARDS, and mortality.

Main Results:

• Among 3,245 patients, 474 had negative initial CXRs.
• Negative CXR results were associated with low probabilities of adverse outcomes (e.g., hospital admission, mechanical ventilation, ARDS, mortality).
• In a subset of younger patients with symptoms for at least 5 days, no deaths occurred, and negative likelihood ratios for adverse outcomes were notably low.

Conclusions:

• Initial CXR in suspected COVID-19 cases is a robust exclusionary tool for adverse clinical outcomes.
• The exclusionary value of CXR is most pronounced in younger adults, those with minimal comorbidities, and individuals with prolonged symptom duration.