RT Journal Article SR Electronic T1 The prognostic value of chest X-ray in patients with COVID-19 on admission and when starting CPAP JF Clinical Medicine JO Clin Med FD Royal College of Physicians SP e14 OP e19 DO 10.7861/clinmed.2020-0576 VO 21 IS 1 A1 Will Sargent A1 Sajeed Ali A1 Sebi Kukran A1 Miranda Harvie A1 Susanne Soin YR 2021 UL http://www.rcpjournals.org/content/21/1/e14.abstract AB Objective The objective was to explore if chest X-ray severity, assessed using a validated scoring system, predicts patient outcome on admission and when starting continuous positive pressure ventilation (CPAP) for COVID-19.Design The study was a retrospective case-controlled study.Participants There were 163 patients with COVID-19 deemed candidates for CPAP on admission, including 58 who subsequently required CPAP.Outcome measures On admission, we measured the proportion of patients meeting a composite ‘negative’ outcome of requiring CPAP, intubation or dying versus successful ward-based care. For those escalated to CPAP, ‘negative’ outcomes were intubation or death versus successful de-escalation of respiratory support.Results Our results were stratified into tertiles, those with ‘moderate’ or ‘severe’ X-rays on admission had significantly higher odds of negative outcome versus ‘mild’ (odds ratio (OR) 2.32; 95% confidence interval (CI) 1.121–4.803; p=0.023; and OR 3.600; 95% CI 1.681–7.708; p=0.001, respectively). This could not be demonstrated in those commencing CPAP (OR 0.976; 95% CI 0.754–1.264; p=0.856).Conclusions We outline a scoring system to stratify X-rays by severity and directly link this to prognosis. However, we were unable to demonstrate this association in the patients commencing CPAP.