@article {1675131,
	title = {Semi-quantitative visual assessment of chest radiography is associated with clinical outcomes in critically ill patients},
	journal = {Respir Res},
	volume = {20},
	number = {1},
	year = {2019},
	month = {2019 Oct 12},
	pages = {218},
	abstract = {BACKGROUND: Respiratory pathology is a major driver of mortality in the intensive care unit (ICU), even in the absence of a primary respiratory diagnosis. Prior work has demonstrated that a visual scoring system applied to chest radiographs (CXR) is associated with adverse outcomes in ICU patients with Acute Respiratory Distress Syndrome (ARDS). We hypothesized that a simple, semi-quantitative CXR score would be associated with clinical outcomes for the general ICU population, regardless of underlying diagnosis.

METHODS: All individuals enrolled in the Registry of Critical Illness at Brigham and Women{\textquoteright}s Hospital between June 2008 and August 2018 who had a CXR within 24 h of admission were included. Each patient{\textquoteright}s CXR was assigned an opacification score of 0-4 in each of four quadrants with the total score being the sum of all four quadrants. Multivariable negative binomial, logistic, and Cox regression, adjusted for age, sex, race, immunosuppression, a history of chronic obstructive pulmonary disease, a history of congestive heart failure, and APACHE II scores, were used to assess the total score{\textquoteright}s association with ICU length of stay (LOS), duration of mechanical ventilation, in-hospital mortality, 60-day mortality, and overall mortality, respectively.

RESULTS: A total of 560 patients were included. Higher CXR scores were associated with increased mortality; for every one-point increase in score, in-hospital mortality increased 10\% (OR 1.10, CI 1.05-1.16, p \< 0.001) and 60-day mortality increased by 12\% (OR 1.12, CI 1.07-1.17, p \< 0.001). CXR scores were also independently associated with both ICU length of stay (rate ratio 1.06, CI 1.04-1.07, p \< 0.001) and duration of mechanical ventilation (rate ratio 1.05, CI 1.02-1.07, p \< 0.001).

CONCLUSIONS: Higher values on a simple visual score of a patient{\textquoteright}s CXR on admission to the medical ICU are associated with increased in-hospital mortality, 60-day mortality, overall mortality, length of ICU stay, and duration of mechanical ventilation.},
	keywords = {Adult, Aged, APACHE, Biomarkers, Critical Illness, Female, Hospital Mortality, Humans, Length of Stay, Lung, Male, Middle Aged, Organ Size, Respiration, Artificial, Respiratory Distress Syndrome, Retrospective Studies, Thorax, Treatment Outcome},
	issn = {1465-993X},
	doi = {10.1186/s12931-019-1201-0},
	author = {Mason, Stefanie E and Dieffenbach, Paul B and Englert, Joshua A and Rogers, Angela A and Massaro, Anthony F and Fredenburgh, Laura E and Higuera, Angelica and Pinilla-Vera, Mayra and Vilas, Marta and Estepar, Raul San Jose and Washko, George R and Baron, Rebecca M and Ash, Samuel Y}
}