Modified Brixia chest X‐ray severity scoring system and correlation with intubation, non‐invasive ventilation and death in a hospitalised COVID‐19 cohort

Abstract Introduction There are few existing severity scoring systems in the literature, and no formally widely accepted chest X‐ray template for reporting COVID‐19 infection. We aimed to modify the chest X‐ray COVID‐19 severity scoring system from the Brixia scoring system with placement of more emphasis on consolidation and to assess if the scoring tool could help predict intubation. Methods A severity chest X‐ray scoring system was modified from the Brixia scoring system. PCR positive COVID‐19 positive patient’s chest X‐rays admitted to our hospital over 3 months were reviewed and correlated with; non‐invasive ventilation, intubation and death. An analysis was performed using a receiver operating curve to predict intubation from all admission chest X‐rays. Results The median score of all 325 admission chest X‐rays was 3 (Interquartile range (IQR) 0–6.5). The median score of admission chest X‐rays of those who did not require ICU admission and survived was 1.5 (IQR 0–5); and 9 (IQR 4.75–12) was median admission score of those requiring intubation. The median scores of the pre‐intubation ICU chest X‐rays was 11.5 (IQR 9–14.125), this increased from a median admission chest X‐ray score for this group of 9 ( P ‐value < 0.01). A cut‐off score of 6 had a sensitivity of 77% and specificity of 73% in predicting the need for intubation. Conclusion Higher chest X‐ray severity scores are associated with intubation, need for non‐invasive ventilation and death. This tool may also be helpful in predicting intubation.