Combining initial radiographs and clinical variables improves deep learning prognostication in patients with covid-19 from the emergency department

Purpose: To train a deep learning classification algorithm to predict chest radiograph severity scores and clinical outcomes in patientwith coronavirus disease 2019 (COVID-19). Materials and Methods: In this retrospective cohort study, patients aged 21–50 years who presented to the emergency department (ED) a multicenter urban health system from March 10 to 26, 2020, with COVID-19 confirmation at real-time reverse-transcription polmerase chain reaction screening were identified. The initial chest radiographs, clinical variables, and outcomes, including admission, tubation, and survival, were collected within 30 days (n = 338; median age, 39 years; 210 men). Two fellowship-trained cardiothoracradiologists examined chest radiographs for opacities and assigned a clinically validated severity score. A deep learning algorithm was trained to predict outcomes on a holdout test set composed of patients with confirmed COVID-19 who presented between March 2and 29, 2020 (n = 161; median age, 60 years; 98 men) for both younger (age range, 21–50 years; n = 51) and older (age >50 years, = 110) populations. Bootstrapping was used to compute CIs. Results: The model trained on the chest radiograph severity score produced the following areas under the receiver operating characteistic curves (AUCs): 0.80 (95% CI: 0.73, 0.88) for the chest radiograph severity score, 0.76 (95% CI: 0.68, 0.84) for admission, 0.6(95% CI: 0.56, 0.75) for intubation, and 0.59 (95% CI: 0.49, 0.69) for death. The model trained on clinical variables produced an AUC of 0.64 (95% CI: 0.55, 0.73) for intubation and an AUC of 0.59 (95% CI: 0.50, 0.68) for death. Combining chest radiography and clinical variables increased the AUC of intubation and death to 0.88 (95% CI: 0.79, 0.96) and 0.82 (95% CI: 0.72, 0.91), respectively. Conclusion: The combination of imaging and clinical information improves outcome predictions.