Semi-quantitative visual assessment of chest radiography is associated with clinical outcomes in critically ill patients.
BACKGROUND
Respiratory pathology is a major driver of mortality in the intensive care unit (ICU), even in the absence of a primary respiratory diagnosis. Prior work has demonstrated that a visual scoring system applied to chest radiographs (CXR) is associated with adverse outcomes in ICU patients with Acute Respiratory Distress Syndrome (ARDS). We hypothesized that a simple, semi-quantitative CXR score would be associated with clinical outcomes for the general ICU population, regardless of underlying diagnosis.


METHODS
All individuals enrolled in the Registry of Critical Illness at Brigham and Women's Hospital between June 2008 and August 2018 who had a CXR within 24 h of admission were included. Each patient's CXR was assigned an opacification score of 0-4 in each of four quadrants with the total score being the sum of all four quadrants. Multivariable negative binomial, logistic, and Cox regression, adjusted for age, sex, race, immunosuppression, a history of chronic obstructive pulmonary disease, a history of congestive heart failure, and APACHE II scores, were used to assess the total score's association with ICU length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, 60-day mortality, and overall mortality, respectively.


RESULTS
A total of 560 patients were included. Higher CXR scores were associated with increased mortality; for every one-point increase in score, in-hospital mortality increased 10% (OR 1.10, CI 1.05-1.16, p < 0.001) and 60-day mortality increased by 12% (OR 1.12, CI 1.07-1.17, p < 0.001). CXR scores were also independently associated with both ICU length of stay (rate ratio 1.06, CI 1.04-1.07, p < 0.001) and duration of mechanical ventilation (rate ratio 1.05, CI 1.02-1.07, p < 0.001).


CONCLUSIONS
Higher values on a simple visual score of a patient's CXR on admission to the medical ICU are associated with increased in-hospital mortality, 60-day mortality, overall mortality, length of ICU stay, and duration of mechanical ventilation.
['Mason|Stefanie E|SE|http://orcid.org/0000-0002-7649-9026', 'Dieffenbach|Paul B|PB|', 'Englert|Joshua A|JA|', 'Rogers|Angela A|AA|', 'Massaro|Anthony F|AF|', 'Fredenburgh|Laura E|LE|', 'Higuera|Angelica|A|', 'Pinilla-Vera|Mayra|M|', 'Vilas|Marta|M|', 'San Jose Estepar|Raul|R|', 'Washko|George R|GR|', 'Baron|Rebecca M|RM|', 'Ash|Samuel Y|SY|']
D018806:APACHE D000328:Adult D000368:Aged D015415:Biomarkers D016638:Critical Illness D005260:Female D017052:Hospital Mortality D006801:Humans D007902:Length of Stay D008168:Lung D008297:Male D008875:Middle Aged D009929:Organ Size D012121:Respiration, Artificial D012128:Respiratory Distress Syndrome D012189:Retrospective Studies D013909:Thorax D016896:Treatment Outcome
Radiography Critical illness Intensive care units Hospital mortality Severity of illness index