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ABSTRACT Objective: To assess chest x-ray appearance of patients with positive RT-PCR test for SARS-Cov-2 and utilize modified RALE score for severity assessment of chest x-ray findings for correlation with clinical spectrum of disease Study Design: Prospective observational study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Pak Emirates Military Hospital, Rawalpindi, from Apr 2020 to May 2020 Methodology: First 1000 consecutive chest x-rays of COVID-19 patients with RT-PCR confirmation at our setup were analyzed Positive chest x-rays were assessed for consolidation, ground glass opacities and location of involvement A severity index using modified RALE score was calculated for each and both lungs Results: Nine hundred and thirty two patients were males and 68 were females with an average age of 40 77 years ± 13 58 Out of 1000 patients, 759 (75 9%) had normal chest x-rays Two hundred and forty one patients had positive findings, ground glass opacities being the most frequent feature 211 (87 6%) showing peripheral 219 (90 9%), bilateral 182 (75 5%) and lower zone predominance 221 (91 7%) The optimal modified RALE score threshold for recognizing severe disease was 4 5 (area under curve, 0 943), with 79 2% sensitivity and 96 3% specificity Conclusion: COVID-19 patients with positive chest x-ray findings frequently showed ground glass opacities with bilateral lower zone involvement in peripheral distribution Modified RALE score can be used for objective evaluation of clinically severe patients
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