Kiran Hilal1, Jehanzeb Shahid1, Abdullah Ameen2, Russell Seth Martins3, Avinash Nankani4, Tanveer Ul Haq1, Ainan Arshad5. 1. Department of Radiology, Aga Khan University, Karachi, Pakistan. 2. KRL Hospital Islamabad, Pakistan. 3. Medical College, Aga Khan University, Karachi, Pakistan. 4. Medical College, Dow University of Health Sciences, Karachi, Pakistan. 5. Department of Medicine, Aga Khan University, Karachi, Pakistan.
Abstract
BACKGROUND: Though various computerized tomography (CT) severity scores have been described for risk prognostication for coronavirus disease 2019 (COVID-19), most are challenging to calculate and have variable inter-observer agreement. The objective of this study was to develop a simple CT severity score (CT-SS) with good inter-observer agreement and assess its correlation with clinical outcome. METHODS: This retrospective study was conducted at the Aga Khan University Hospital (AKUH), from April-August 2020. All patients who were PCR positive for COVID-19 and underwent CT chest examination at AKUH were included. Severity of disease was described on the basis of a 10-point CT severity score (CT-SS) devised at our institution. CT-SS were categorized as Low (0-7) and High (8-10). Inter-observer reliability between radiologist and COVID-19 intensivist was assessed using the Kappa statistic. RESULTS: A total of 73 patients were included, the majority male (58.9%) with mean age 55.8±13.93 years. The CT-SS rated on 0-10 showed substantial inter-observer reliability between radiologist and intensivist with a Kappa statistic of 0.78. Patients with CT-SS 8-10 had a significantly higher ICU admission & intubation rate (53.8% vs. 23.5%) and mortality rate (35.9% vs. 11.8%; p=0.017), as compared to those with CT-SS 0-7. CONCLUSIONS: We conclude that the described CT severity score (CT-SS) is a quick, effective, and easily reproducible tool for prediction of adverse clinical outcome in patients with COVID 19 pneumonia. The tool shows good inter-observer agreement when calculated by radiologist and physician independently.
BACKGROUND: Though various computerized tomography (CT) severity scores have been described for risk prognostication for coronavirus disease 2019 (COVID-19), most are challenging to calculate and have variable inter-observer agreement. The objective of this study was to develop a simple CT severity score (CT-SS) with good inter-observer agreement and assess its correlation with clinical outcome. METHODS: This retrospective study was conducted at the Aga Khan University Hospital (AKUH), from April-August 2020. All patients who were PCR positive for COVID-19 and underwent CT chest examination at AKUH were included. Severity of disease was described on the basis of a 10-point CT severity score (CT-SS) devised at our institution. CT-SS were categorized as Low (0-7) and High (8-10). Inter-observer reliability between radiologist and COVID-19 intensivist was assessed using the Kappa statistic. RESULTS: A total of 73 patients were included, the majority male (58.9%) with mean age 55.8±13.93 years. The CT-SS rated on 0-10 showed substantial inter-observer reliability between radiologist and intensivist with a Kappa statistic of 0.78. Patients with CT-SS 8-10 had a significantly higher ICU admission & intubation rate (53.8% vs. 23.5%) and mortality rate (35.9% vs. 11.8%; p=0.017), as compared to those with CT-SS 0-7. CONCLUSIONS: We conclude that the described CT severity score (CT-SS) is a quick, effective, and easily reproducible tool for prediction of adverse clinical outcome in patients with COVID 19 pneumonia. The tool shows good inter-observer agreement when calculated by radiologist and physician independently.