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Cocconcelli E, Biondini D, Giraudo C, Lococo S, Bernardinello N, Fichera G, Barbiero G, Castelli G, Cavinato S, Ferrari A, Saetta M, Cattelan A, Spagnolo P, Balestro E. Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19. J Clin Med 2020; 9:E2990. [PMID: 32947904 PMCID: PMC7565657 DOI: 10.3390/jcm9092990] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic with lung disease representing the main cause of morbidity and mortality. Conventional chest-X ray (CXR) and ultrasound (US) are valuable instruments to assess the extent of lung involvement. We investigated the relationship between CXR scores on admission and the level of medical care required in patients with COVID-19. Further, we assessed the CXR-US correlation to explore the role of ultrasound in monitoring the course of COVID-19 pneumonia. Clinical features and CXR scores were obtained at admission and correlated with the level of intensity of care required [high- (HIMC) versus low-intensity medical care (LIMC)]. In a subgroup of patients, US findings were correlated with clinical and radiographic parameters. On hospital admission, CXR global score was higher in HIMCs compared to LIMC. Smoking history, pO2 on admission, cardiovascular and oncologic diseases were independent predictors of HIMC. The US score was positively correlated with FiO2 while the correlation with CXR global score only trended towards significance. Our study identifies clinical and radiographic features that strongly correlate with higher levels of medical care. The role of lung ultrasound in this setting remains undetermined and needs to be explored in larger prospective studies.
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Affiliation(s)
- Elisabetta Cocconcelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padova, Italy; (E.C.); (D.B.); (S.L.); (N.B.); (M.S.); (P.S.)
| | - Davide Biondini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padova, Italy; (E.C.); (D.B.); (S.L.); (N.B.); (M.S.); (P.S.)
| | - Chiara Giraudo
- Department of Medicine, Institute of Radiology, University of Padova, 35128 Padova, Italy; (C.G.); (G.F.); (G.B.)
| | - Sara Lococo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padova, Italy; (E.C.); (D.B.); (S.L.); (N.B.); (M.S.); (P.S.)
| | - Nicol Bernardinello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padova, Italy; (E.C.); (D.B.); (S.L.); (N.B.); (M.S.); (P.S.)
| | - Giulia Fichera
- Department of Medicine, Institute of Radiology, University of Padova, 35128 Padova, Italy; (C.G.); (G.F.); (G.B.)
| | - Giulio Barbiero
- Department of Medicine, Institute of Radiology, University of Padova, 35128 Padova, Italy; (C.G.); (G.F.); (G.B.)
| | - Gioele Castelli
- School of Medicine, University of Padova, 35128 Padova, Italy;
| | - Silvia Cavinato
- Division of Infectious and Tropical Diseases, Azienda Ospedaliera and University of Padova, 35128 Padova, Italy; (S.C.); (A.F.); (A.C.)
| | - Anna Ferrari
- Division of Infectious and Tropical Diseases, Azienda Ospedaliera and University of Padova, 35128 Padova, Italy; (S.C.); (A.F.); (A.C.)
| | - Marina Saetta
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padova, Italy; (E.C.); (D.B.); (S.L.); (N.B.); (M.S.); (P.S.)
| | - Annamaria Cattelan
- Division of Infectious and Tropical Diseases, Azienda Ospedaliera and University of Padova, 35128 Padova, Italy; (S.C.); (A.F.); (A.C.)
| | - Paolo Spagnolo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padova, Italy; (E.C.); (D.B.); (S.L.); (N.B.); (M.S.); (P.S.)
| | - Elisabetta Balestro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, 35128 Padova, Italy; (E.C.); (D.B.); (S.L.); (N.B.); (M.S.); (P.S.)
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Foust AM, McAdam AJ, Chu WC, Garcia-Peña P, Phillips GS, Plut D, Lee EY. Practical guide for pediatric pulmonologists on imaging management of pediatric patients with COVID-19. Pediatr Pulmonol 2020; 55:2213-2224. [PMID: 32462724 PMCID: PMC7283678 DOI: 10.1002/ppul.24870] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/26/2022]
Abstract
Understanding of coronavirus disease 2019 is rapidly evolving with new articles on the subject daily. This flood of articles can be overwhelming for busy practicing clinicians looking for key pieces of information that can be applied in daily practice. This review article synthesizes the reported imaging findings in pediatric Coronavirus disease 2019 (COVID-19) across the literature, offers imaging differential diagnostic considerations and useful radiographic features to help differentiate these entities from COVID-19, and provides recommendations for requesting imaging studies to evaluate suspected cases of pediatric COVID-19.
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Affiliation(s)
- Alexandra M Foust
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexander J McAdam
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Winnie C Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Pilar Garcia-Peña
- Department of Pediatric Radiology, University Hospital Materno-Infantil Vall d'Heborn, Barcelona, Spain
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Domen Plut
- Department of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Pediatric SARS, H1N1, MERS, EVALI, and Now Coronavirus Disease (COVID-19) Pneumonia: What Radiologists Need to Know. AJR Am J Roentgenol 2020; 215:736-744. [PMID: 32352308 DOI: 10.2214/ajr.20.23267] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. The purpose of this article is to review new pediatric lung disorders-including disorders that have occurred in recent years years such as severe acute respiratory syndrome (SARS), swine-origin influenza A (H1N1), Middle East respiratory syndrome (MERS), e-cigarette or vaping product use-associated lung injury (EVALI), and coronavirus disease (COVID-19) pneumonia-to enhance understanding of the characteristic imaging findings. CONCLUSION. Although the clinical symptoms of SARS, H1N1, MERS, EVALI, and COVID-19 pneumonia in pediatric patients may be nonspecific, some characteristic imaging findings have emerged or are currently emerging. It is essential for radiologists to have a clear understanding of the characteristic imaging appearances of these lung disorders in pediatric patients to ensure optimal patient care.
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Abelleira R, Ruano-Ravina A, Lama A, Barbeito G, Toubes ME, Domínguez-Antelo C, González-Barcala FJ, Rodríguez-Núñez N, Marcos PJ, Pérez del Molino ML, Valdés L. Influenza A H1N1 Community-Acquired Pneumonia: Characteristics and Risk Factors-A Case-Control Study. Can Respir J 2019; 2019:4301039. [PMID: 31007805 PMCID: PMC6441515 DOI: 10.1155/2019/4301039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/06/2019] [Accepted: 02/19/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction Influenza A H1N1 community-acquired pneumonia (CAP) is a quite frequent respiratory disease. Despite being considered more serious than other CAPs, there are very few studies comparing its characteristics with noninfluenza CAP. We aim to establish the differences between pneumonia due to H1N1 virus and pneumonia not caused by H1N1 influenza virus and to determine the probability that a pneumonia is due to an H1N1 virus infection based on the most relevant variables. Methods We used a case-control study where cases were H1N1 CAP patients with confirmed microbiological diagnosis and controls were patients with CAP admitted to hospital. H1N1 and other influenza types were discarded among controls. We calculated the probability of being a case or control using multivariate logistic regression. Results We included 99 cases and 270 controls. Cases were younger than controls (53 vs 71 years, respectively). Mortality was much higher for H1N1 patients (13% vs 0.3%), and admission to intensive care unit was more frequent for H1N1 cases. The variables most associated with presenting H1N1 CAP were bilateral affectation on chest X-rays (OR: 5.70; 95% CI 2.69-10.40), followed by presence of arthromyalgias, with cases presenting close to three times more arthromyalgias compared to controls. Low leukocytes count and high AST values were also significantly associated with H1N1 CAP. H1N1 CAPs are characterized by bilateral affectation, low leukocyte count, presence of arthromyalgias, and high AST. Conclusions A few and easy to obtain clinical parameters might be extremely useful to distinguish H1N1 CAP from CAPs of other origin.
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Affiliation(s)
- Romina Abelleira
- Service of Pneumology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Group of Epidemiology, Public Health and Evaluation of Health Services, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Adriana Lama
- Service of Pneumology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gema Barbeito
- Service of Microbiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - María E. Toubes
- Service of Pneumology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristina Domínguez-Antelo
- Critical Care Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco J. González-Barcala
- Service of Pneumology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Interdisciplinary Research Group in Pneumology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Service of Pneumology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pedro J. Marcos
- Service of Pneumology, University Hospital of A Coruña, A Coruña, Spain
| | - María L. Pérez del Molino
- Service of Microbiology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Luis Valdés
- Service of Pneumology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Interdisciplinary Research Group in Pneumology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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