Researchers reported chest X-rays performed on young and middle-aged adults with COVID-19 when they arrive in the emergency department (ED) can help providers predict which patients are at high risk of severe illness and likely will require intubation.1

In a retrospective review of 338 patients between age 21 and 50 years with confirmed COVID-19 diagnoses, researchers used a unique scoring system to evaluate illness severity based on patterns in the lungs that could be seen in chest X-rays.

Investigators reported each chest X-ray was divided into six zones (three zones per lung) and examined for opacities, the white circular markings associated with COVID-19, by two cardiothoracic radiologists. The scores were correlated into a total lung zone severity score based on the presence or absence of opacity in each zone. A chest X-ray score of 3 or higher was an independent predictor of intubation.

Among the patients studied, 145 were admitted. Patients with the highest lung zone severity scores were 6.2 times more likely to require hospitalization and 4.7 times more likely to require intubation.

The authors noted that while men were more likely than women to record higher lung severity scores and to be admitted, they were not more likely to be intubated.

Further, the researchers found no significant differences in outcomes based on race or ethnicity when the data were adjusted for other factors such as age, gender, weight, and comorbid conditions.

Investigators noted this is the first study to demonstrate the value of using X-rays in the ED to predict how sick COVID-19 patients are likely to become, and potentially use this information to allocate resources and expedite needed treatment in the most severe cases.


  1. Toussie D, Voutsinas N, Finkelstein M, et al. Clinical and chest radiography features determine patient outcomes in young and middle age adults with COVID-19. Radiology 2020; May 14;201754. doi: 10.1148/radiol.2020201754. [Online ahead of print].