TY - JOUR T1 - Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00655-2020 SP - 00655-2020 AU - Rebecca F. D'Cruz AU - Michael D. Waller AU - Felicity Perrin AU - Jimstan Periselneris AU - Sam Norton AU - Laura-Jane Smith AU - Tanya Patrick AU - David Walder AU - Amadea Heitmann AU - Kai Lee AU - Rajiv Madula AU - William McNulty AU - Patricia Macedo AU - Rebecca Lyall AU - Geoffrey Warwick AU - James B. Galloway AU - Surinder S. Birring AU - Amit Patel AU - Irem Patel AU - Caroline J. Jolley Y1 - 2020/01/01 UR - http://openres.ersjournals.com/content/early/2020/10/15/23120541.00655-2020.abstract N2 - Background A standardised approach to assessing COVID-19 survivors has not been established, largely due to the paucity of data on medium- and long-term sequelae. Interval chest radiograph is recommended following community-acquired pneumonia, however its utility in monitoring recovery from COVID-19 pneumonia remains unclear.Methods Prospective single-centre observational cohort study. Patients hospitalised with severe COVID-19 pneumonia (admission duration ≥48 h and oxygen requirement ≥40% or critical care admission) underwent face-to-face assessment 4–6 weeks post-discharge. Primary outcome: radiological resolution of COVID-19 pneumonitis (Radiographic Assessment of Lung Oedema score <5). Secondary outcomes: clinical outcomes, symptom questionnaires, mental health screening (Trauma Screening Questionnaire, GAD-7, PHQ-9), physiological testing (4-metre gait speed (4MGS), 1-minute sit-to-stand test (STS)).Results 119 patients assessed between 3rd June and 2nd July 2020 at median (IQR) 61 (51–67) days post-discharge. Mean±sd age 58.7±14.4 years, body mass index 30.0 (25.9–35.2) kg·m−2, 62% male, 68% ethnic minority. Despite radiographic resolution of pulmonary infiltrates in 87%, mMRC breathlessness scores were above pre-COVID baseline in 46% and patients reported persistent fatigue (68%), sleep disturbance (57%) and breathlessness (32%). Screening thresholds were breached for post-traumatic stress disorder (25%), anxiety (22%) and depression (18%). 4MGS was slow (<0.8 m·s−1) in 38%, 35% desaturated by ≥4% during STS. Of 56 thoracic computed tomography scans performed, 75% demonstrated COVID-related interstitial and/or airways disease.Conclusions Persistent symptoms, adverse mental health outcomes and physiological impairment are common 2 months after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery, therefore holistic face-to-face assessment is recommended to facilitate early recognition and management of post-COVID sequelae.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. D'Cruz has nothing to disclose.Conflict of interest: Dr. Waller has nothing to disclose.Conflict of interest: Dr. Perrin has nothing to disclose.Conflict of interest: J. Periselneris reports lecture fees from Gilead outside the submitted work.Conflict of interest: Dr. Norton has nothing to disclose.Conflict of interest: Dr. LJ Smith has nothing to disclose.Conflict of interest: Dr. Patrick has nothing to disclose.Conflict of interest: Dr. Walder has nothing to disclose.Conflict of interest: Dr. Heitmann has nothing to disclose.Conflict of interest: Dr. Lee has nothing to disclose.Conflict of interest: Dr. Madula has nothing to disclose.Conflict of interest: Dr. McNulty has nothing to disclose.Conflict of interest: Dr. Macedo has nothing to disclose.Conflict of interest: Dr. lyall has nothing to disclose.Conflict of interest: Dr. Warwick has nothing to disclose.Conflict of interest: Dr. Galloway has nothing to disclose.Conflict of interest: Dr. Birring has nothing to disclose.Conflict of interest: Dr. Patel has nothing to disclose.Conflict of interest: Dr. Patel has nothing to disclose.Conflict of interest: Dr. Jolley has nothing to disclose. ER -