Chest x-ray patterns and clinical outcomes of COVID-2019 patients at Queen Elizabeth Central Hospital, Malawi

Chest x-ray (CXR) is a low-radiation, widely accessible, and cheap imaging tool with a mobile option for COVID-2019 patients’ prognosis and monitoring, but the use of its findings to predict patient outcomes has not been evaluated. Computed Tomography (CT) is the gold standard but costly with high radiation doses. This study aims to describe CXR patterns and relate them to clinical outcomes of COVID-2019 patients admitted to the Queen Elizabeth Central Hospital (QECH) isolation ward in Malawi. This cross-sectional study included 216 CXR images and files of COVID-2019 patients aged 18 and above admitted to the QECH COVID-2019 isolation ward from June to August 2021. Images were reviewed by two radiologists with over 10 years of experience, blinded from each other and findings were recorded in a predesigned questionnaire by the researchers. A tiebreaker was involved where the two reports disagreed. Data analysis was done using STATA version 13. Out of the 216 CXR images analyzed, 177 (81.9%) had COVID-2019-related CXR patterns with abnormal Brixia scores, while 39 (18.1%) had normal patterns with Brixia score of 0. On clinical outcome, 114 (52.8%) patients were discharged home while 51 (23.6%) died in the hospital and another 51 (23.6%) did not have documentation. The prevalence of home discharge was 62% lower among patients with ground glass opacities (GGO) [prevalence risk ratio (PRR) = 0.383 95% CI = 0.258–0.569; P < 0.001] and almost 50% lower among patients with consolidations [PRR = 0.448; 95% CI = 0.318–0.632; p < 0.001] compared to patients with normal CXR patterns. Similarly, the prevalence of home discharge alive among patients with severe Brixia scores was 50% lower than normal Brixia scores [PRR = 0.496; 95 CI = 0.355–0.693; p < 0.001]. The study found that most COVID-2019 patients had abnormal CXR patterns and Brixia scores. GGO and consolidations were the most common patterns with many patients having severe Brixia scores. The abnormal patterns and severe Brixia scores were negatively associated with home discharge.