The role of initial chest X-ray in triaging patients with suspected COVID-19 during the pandemic

Hyunjoong W. Kim, K. M. Capaccione, Gen Li, Lyndon Luk, Reginald S. Widemon, Ozair Rahman, Volkan Beylergil, Ryan Mitchell, Belinda M. D’Souza, Jay S. Leb, Shifali Dumeer, Stuart Bentley-Hibbert, Michael Liu, Sachin Jambawalikar, John H.M. Austin, Mary Salvatore

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Purpose: The purpose of our research is to evaluate the usefulness of chest X-ray for triaging patients with suspected COVID-19 infection. Methods: IRB approval was obtained to allow a retrospective review of adult patients who presented to the Emergency Department with a complaint of fever, cough, dyspnea or hypoxia and had a chest X-ray between 12 March 2020 and 26 March 2020. The initial chest X-ray was graded on a scale of 0–3 with grade 0 representing no alveolar opacities, grade 1: < 1/3 alveolar opacities of the lung, Grade 2: 1/3 to 2/3 lung with alveolar opacities and grade 3: > 2/3 alveolar opacities of the lung. Past medical history of diabetes and hypertension, initial oxygen saturation, COVID-19 testing results, intubation, and outcome were also collected. Results: Four hundred ten patient chest X-rays were reviewed. Oxygen saturation and X-ray grade were both significantly associated with the length of stay in hospital, the hazard ratio (HR) of discharge was 1.05 (95% CI [1.01, 1.09], p = 0.017) and 0.61 (95% CI [0.51, 0.73], p < 0.001), respectively. In addition, oxygen saturation and X-ray grade were significant predictors of intubation (odds ratio (OR) of intubation is 0.88 (95% CI [0.81, 0.96], p = 0.004) and 3.69 (95% CI [2.25, 6.07], p < 0.001). Conclusions: Initial chest X-ray is a useful tool for triaging those subjects who might have poor outcomes with suspected COVID-19 infection and benefit most from hospitalization.

Original languageEnglish
Pages (from-to)617-621
Number of pages5
JournalEmergency Radiology
Issue number6
StatePublished - Dec 2020
Externally publishedYes


  • COVID-19
  • CXR
  • Chest
  • Coronavirus
  • SARS-CoV-2
  • X-ray


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