Observational study of clinico-radiological follow-up of COVID-19 pneumonia: a district general hospital experience in the UK

• Published in: BMC infectious diseases Vol. 21; no. 1; p. 1233
• Main Authors: Musat, C A, Hadzhiivanov, M, Durkowski, V, Banerjee, A, Chiphang, A, Diwan, M, Mahmood, M S, Shami, M N, Nune, A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.12.2021; BioMed Central; BMC
• Subjects: Bacterial pneumonia; British Thoracic Society; Chronic obstructive pulmonary disease; Complications; Complications and side effects; Coronaviruses; COVID-19; COVID-19 pneumonia; CXR; Diagnosis; Embolism; Fibrosis; Infectious diseases; Interstitial lung disease; Lung diseases; Mortality; Observational studies; Patient admissions; Patients; Pneumonia; Pulmonary embolisms; Pulmonary vascular disease; Severe acute respiratory syndrome coronavirus 2; Thorax; United Kingdom; United Kingdom > UK; Pulmonary vascular disease; British Thoracic Society; COVID-19 pneumonia; CXR; Interstitial lung disease
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-06941-8

The British Thoracic Society (BTS) recommends that all patients admitted with COVID-19 pneumonia should have a chest X-ray (CXR) and clinical follow-up at 6 or 12 weeks, depending on the disease severity. Little data is available on long-term CXR follow-up for moderate and severe COVID-19 pneumonia. This study aims to evaluate compliance with clinico-radiological follow-up of patients recovering from COVID-19 pneumonia at a local hospital in the UK, as per the BTS guidance, and to analyse radiological changes at clinical follow-up at 12 weeks, in order to risk-stratify and improve patient outcomes. This is a single-centre retrospective audit of 255 consecutive COVID-19 positive patients admitted to a local hospital in the UK over 5 months between May and October 2020. All CXRs and clinic follow-up at 12 ± 8 weeks were checked on an electronic database. Over one in two (131/255) patients had CXR evidence of COVID-19 pneumonia during the initial hospital admission. Half of the patients (60/131) died before CXR or clinic follow-up. Fifty-eight percent (41/71) of the surviving patients had a follow-up CXR, and only two developed respiratory complications- one had residual lung fibrosis, another a pulmonary embolism. Eighty-eight percent (36/41) of the patients had either resolution or improved radiological changes at follow-up. Most patients who had abnormal follow-up CXR were symptomatic (6/8), and many asymptomatic patients at follow-up had a normal CXR (10/12). Although there were concerns about interstitial lung disease (ILD) incidence in patients with COVID-19 pneumonia, most of our patients with COVID-19 pneumonia had no pulmonary complications at follow-up with CXR. This emphasises that CXR, a cost-effective investigation, can be used to risk-stratify patients for long term pulmonary complications following their COVID-19 pneumonia. However, we acknowledge the limitations of a low CXR and clinic follow-up rate in our cohort.