Sextus chest radiograph severity score correlates to clinical outcomes in patients with COVID-19: A cross-sectional study.

ABSTRACT: The value of chest radiography (CXR) in detection and as an outcome predictor in the management of patients with coronavirus disease-2019 (COVID-19) has not yet been fully understood.To validate a standardized CXR scoring system and assess its prognostic value in hospitalized patients found to have COVID-19 by imaging criteria and to compare it to computed tomography (CT).In this cross-sectional chart review study, patients aged 18-years or older who underwent chest CT at a single institution with an imaging-based diagnosis of COVID-19 between March 15, 2020 to April 15, 2020 were included. Each patient's CXR and coronal CT were analyzed for opacities in a 6-zonal assessment method and aggregated into a "Sextus score." Inter-reader variability and correlation between CXR and coronal CT images were investigated to validate this scoring system. Univariable and multiple logistic regression techniques were used to investigate relationships between CXR scores and clinical parameters in relation to patient outcomes.One hundred twenty-four patients (median [interquartile range] age 58.5 [47.5-69.0] years, 72 [58%] men, 58 [47%] Blacks, and 35 [28%] Hispanics) were included. The CXR Sextus score (range: 0-6) was reliable (inter-rater kappa = 0.76; 95% confidence interval [CI]: 0.69-0.83) and correlated strongly with the CT Sextus score (Spearman correlation coefficient = 0.75, P < .0001). Incremental increases of CXR Sextus scores of 2 points were found to be an independent predictor of intubation (adjusted odds ratio [95% CI]: 4.49 [1.98, 10.20], P = .0003) and prolonged hospitalization (≥10 days) (adjusted odds ratio [95% CI]: 4.06 [1.98, 8.32], P = .0001).The CXR Sextus score was found to be reproducible and CXR-CT severity scores were closely correlated. Increasing Sextus scores were associated with increased risks for intubation and prolonged hospitalization for patients with COVID-19 in a predominantly Black population. The CXR Sextus score may provide insight into identifying and monitoring high-risk patients with COVID-19.

Pitfalls of Extensive Documentation in the Emergency Department.

Background: The law mandates careful record-keeping in the emergency department, and clinical imperatives also support the value of complete and legible reports. A common assumption is that extensive documentation increases the yield of relative value units (RVUs) and higher levels of care, thereby maximizing reimbursement. However, overdocumentation presents certain risks, possibly impacts physician efficiency, and does not ensure that records are more readable and clinically useful. We examined the effect of increased documentation on actual reimbursement. Methods: We conducted a 12-month productivity analysis of patients per hour (pt/h), RVUs per hour (RVU/h), amounts of monies billed, and amounts of monies collected for all full-time supervising physicians in a university emergency medicine training program. Results: RVU/h vs pt/h yielded a positive linear relationship (R2=0.7571) and a strong correlation coefficient of 0.87. RVU/h vs revenue collection (amount actually paid) yielded a moderately positive linear relationship (R2=0.1752), with a correlation coefficient of 0.42. The relationship between pt/h and collections was weak (R2=0.0815), with a correlation coefficient of 0.29. A quartile comparison showed an inflection point, suggesting that after the third quartile, RVU/h did not appear to help generate significantly higher collections. Conclusion: The data, while not definitive, suggest that overly extensive documentation may increase RVU totals but, after a point, does not reliably increase revenue generation.