Chest x-ray at emergency admission and potential association with barotrauma in mechanically ventilated patients: experience from the Italian core of the first pandemic peak
Open accessAbstract
Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to investigate whether the Brixia score (BS) calculated on chest-X-rays acquired at the Emergency Room was associated with barotrauma. We retrospectively evaluated 117 SARS-CoV-2 patients presented to the Emergency Department (ED) and then admitted to the intensive care unit (ICU) for mechanical ventilation between February and April 2020. Subjects were divided into two groups according to the occurrence of barotrauma during their hospitalization. CXRs performed at ED admittance were assessed using the Brixia score. Distribution of barotrauma (pneumomediastinum, pneumothorax, subcutaneous emphysema) was identified in chest CT scans. Thirty-eight subjects (32.5%) developed barotrauma (25 pneumomediastinum, 24 pneumothorax, 24 subcutaneous emphysema). In the barotrauma group we observed higher Brixia score values compared to the non-barotrauma group (mean value 12.18 vs. 9.28), and logistic regression analysis confirmed that Brixia score is associated with the risk of barotrauma. In this work, we also evaluated the relationship between barotrauma and clinical and ventilatory parameters: SOFA score calculated at ICU admittance and number of days of non-invasive ventilation (NIV) prior to intubation emerged as other potential predictors of barotrauma.
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In emergency and intensive care settings, timely interpretation of chest radiographs is essential for guiding clinical decisions, including ventilation management, antibiotic initiation, and imaging referrals.
“In emergency and intensive care settings, timely interpretation of chest radiographs is essential for guiding clinical decisions, including ventilation management, antibiotic initiation, and imaging referrals (7, 8).”
From Swin-Qwen3: a three-stage vision–language framework for automated radiology report generation with multi-agent verification (2026) · cites this paper as [8]
The Discussion says chest X-ray is an early emergency-room investigation and examines whether admission findings identify patients at risk of barotrauma. Methods §2.3 says barotrauma suspected or detected on CXR could prompt CT, supporting the imaging-referral example. The paper does not establish that timely interpretation guides ventilation management or antibiotic initiation. (LLM, conf=0.87)
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References 27 · Cited by 1
- Authors
- Bonaffini, P. A., Stanco, F., Dulcetta, L., Poli, G., Brambilla, P., Marra, P., Valle, C., Lorini, F. L., Mazzoleni, M., Sonzogni, B., Previdi, F., & Sironi, S.
- Affiliations
- Ospedale Papa Giovanni XXIII (IT)
- University of Bergamo (IT)
- Corresponding author
- Bonaffini, Pietro Andrea
- ORCID
- Venue
- Tomography
- Publisher
- MDPI AG
- Published
- 2023-12-08
- Volume
- 9
- Issue
- 6
- Pages
- 2211-2221
- ISSN
- 2379-1381 (ISSN-L)
- 2379-139X
- PMC
- PMC10748272
- OpenAlex
- W4389542132
- Cited by
- 1
- References
- 27
- Citations by year
- 2026: 1
- FWCI
- 0.18
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Tomography (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Aisberg (University of Bergamo) (submittedVersion, cc-by)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pneumothorax, Barotrauma, Emphysema
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- barotrauma, Brixia score, chest radiography, COVID-19 pandemic, SARS-CoV-2, mechanical ventilation, pneumomediastinum, pneumothorax, subcutaneous emphysema, interstitial lung disease, emergency department admission, SOFA score, non-invasive ventilation, risk factors
- MeSH terms
- COVID-19, Barotrauma, Hospitalization, Humans, Italy, Mediastinal Emphysema, Pneumothorax, Respiration, Artificial, Retrospective Studies, Subcutaneous Emphysema, X-Rays, Pandemics
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