ArticleWorld journal of critical care medicine2026
Use of radiograph scoring systems to assess pulmonary disease severity in patients with COVID-19 pneumonia.
Article in World journal of critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Letter to the Editor: Chest X-ray-based severity scores in COVID-19 - what do they tell us about oxygen needs?World journal of critical care medicine · 2026Article
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11 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundSevere acute respiratory syndrome coronavirus 2 causes pneumonia in most hospitalized patients, often leading to hypoxemia and the need for supplemental oxygen. While chest computed tomography is highly sensitive, chest radiographs (CXR) offer a practical alternative in high-volume settings. Scoring systems like Radiographic Assessment of Lung Edema (RALE) and BRIXIA standardize CXR interpretation and quantify severity, but their relationship with oxygen delivery requirements in coronavirus disease 2019 (COVID-19) patients remains unclear.
aimTo evaluate whether the initial emergency department (ED) radiograph could predict subsequent oxygen support requirements. The secondary aim was to assess inter- and intra-rater agreement of the scoring systems.
methodsThis retrospective cohort study examined consecutive COVID-19 patients presenting to a large tertiary hospital ED (May-June 2020) who required admission and underwent CXR within 24 hours of arrival. Infiltrate severity on ED radiographs was scored using the BRIXIA and RALE systems. Oxygen support was categorized by delivery device, and associations were examined using logistic regression.
resultsData was analyzed from 950 COVID-19 patients (90.6% male, mean age: 48.4 ± 12.3 years). Predictive performance showed notable variation: At ED admission, both BRIXIA and RALE scores had the highest discriminatory ability [area under the curve (AUC) = 0.74; 95% confidence interval (CI): 0.69-0.79] for predicting oxygen delivery
conclusionBoth RALE and BRIXIA scores effectively predicted the need for advanced respiratory support in ED COVID-19 patients and demonstrated excellent inter-rater and intra-rater reliability. While their predictive power diminished during hospitalization, both scores remain valuable for initial triage, with BRIXIA particularly useful for ruling out the need for high-level oxygen support.
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