First study to explore CXR findings of urgent care patients with confirmed COVID-19

As urgent care centers find themselves on the front lines of the novel coronavirus, the Journal of Urgent Care Medicine (JUCM) e-published the largest study to date of urgent care (UC) patients with positive SARS-CoV-2 PCR tests. The study, based on 636 chest x-rays from a large urgent care center in New York City amassed by Experity Teleradiology, shows a vast majority of COVID-19 positive patients (89%) with either normal or only mildly abnormal CXRs, despite showing respiratory symptoms of the virus. The study will be published in the May issue of JUCM, which is the official publication of the Urgent Care Association (UCA).

COVID-19, a novel disease caused by the SARS-CoV-2 virus, rapidly became a pandemic in early 2020. During this outbreak, acute care clinicians have been striving to accurately diagnose and define its clinical features in order to provide the best care for afflicted patients and limit the spread of the disease.

"As our collective understanding of the COVID-19 pandemic – how it's spread, who is most at risk and how to check its progression – continues to evolve, one thing that has been lacking is a solid data set derived from clinical experience," said Stuart Williams, publisher of JUCM. "JUCM took a step towards rectifying this shortfall by publishing this comprehensive study, which is a substantial contribution to the growing body of knowledge of COVID-19."

As most patients with COVID-19 seem to have a mild course of respiratory illness, evaluations are most likely to take place in non-emergency department and non-hospital settings, such as UC centers. In such settings, CXR, also known as plain film radiography of the chest, is by far the most widely available imaging modality.

"Urgent care clinicians are often on the front lines of this pandemic, as COVID-19 patients continue to present themselves at urgent care centers across the country," said Laurel Stoimenoff, CEO of the UCA. "This JUCM study emanated from that initial surge in patient traffic and further illustrates the impact urgent care centers have on the health of our communities."

For this study, researchers used a database from a large urgent care company in the greater New York City area to review for patients with positive SARS-CoV-2 PCR tests and who also underwent CXR in urgent care between March 9 and March 24, 2020. The primary objective was to determine what percentage of ambulatory patients with confirmed COVID-19 had normal vs. abnormal CXRs. Secondarily, researchers aimed to describe the frequency of each specific type of abnormal finding on plain film radiography (CXR).

The results show that the vast majority of patients (89%) had either normal or only mildly abnormal CXRs, despite being symptomatic enough to warrant imaging as determined by the treating UC provider. Other findings include:

·         Of the 636 CXRs reviewed among patients with confirmed COVID-19, 363 were male (57.1%) and 273 were female (42.9%).

·         Patient ages ranged from 18 to 90 years of age, with most (77.5%) being 30-70 years old.

·         There were 371 CXRs reread as normal (58.3%).

·         Of the 265 abnormal cases (41.7%), 195 demonstrated mild disease, 65 demonstrated moderate disease and five demonstrated severe disease.

·         Interstitial changes and ground glass opacities (GGO) were the predominant descriptive findings in 151 (23.7%) and 120 (18.9%) of the total, respectively.

·         Location of the abnormalities were in the lower lobe in 215 (33.8%), bilateral in 133 (20.9%) and multifocal in 154 (24.2%).

·         Effusions and lymphadenopathy were uncommon.

To download the full study entitled, "Chest X-Ray Findings in 636 Ambulatory Patients with COVID-19 Presenting to an Urgent Care Center: A Normal Chest X-Ray Is no Guarantee," click here. For more info regarding COVID-19 as it relates to the urgent care industry, visit ucaoa.org/coronavirus.