The association of chest radiographic findings and severity scoring with clinical outcomes in patients with COVID-19 presenting to the emergency department of a tertiary care hospital in Pakistan

Raima Kaleemi; Kiran Hilal; Ainan Arshad; Russell Seth Martins; Avinash Nankani; Haq TU; Sundas Basharat; Zeeshan Ansar

doi:10.1371/journal.pone.0244886

Peer Review History

Original SubmissionAugust 6, 2020
25 Nov 2020 Decision Letter - Francesco Di Gennaro, Editor PONE-D-20-24338 The Association of Chest Radiographic Findings and Severity Scoring with Clinical Outcomes in Patients with COVID-19 Presenting to the Emergency Department of a Tertiary Care Hospital in Pakistan PLOS ONE Dear Dr. Kiran Hilal, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 10 December. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Francesco Di Gennaro Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Additional Editor Comments (if provided): Dear Authors follow revieres suggestion to improve your article [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you very much for your submission. This is a nice study, which could set a nice ground for future research on prognosis and outcome of COVID-19. As a general comment, language and grammar needs revision. It does not deter from the possibility to understand the text, but there are multiple typos. I would also review the format. The tables could be reviewed and perhaps combined, the format could be made homogeneous. The resolution and quality of images should be reviewed . Reviewer #2: This is an high quality article and I appreciate a lot the paper. Only some minor suggestions: - discuss the possible role of ultrasound already in use in other infectious diseases ex tuberculosis and HIV (see and cite Bobbio F, Focused ultrasound to diagnose HIV-associated tuberculosis (FASH) in the extremely resource-limited setting of South Sudan: a cross-sectional study. BMJ Open. 2019 Apr 2;9(4):e027179. doi: 10.1136/bmjopen-2018-027179. PMID: 30944140; PMCID: PMC6500283.) - Gigure 2 is not esay to read for the quality of image. Please add image with high quality ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** SALMAN S. ALBAKHEET Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0244886.r001
Revision 1
14 Dec 2020 Author Response 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Authors’ Response: Thank you. 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Authors’ Response: Thank you. 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Authors’ Response: Thank you. 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes Authors’ Response: Thank you for your comment. We have proofread our manuscript thoroughly and ensured that all the minor typographical and grammatical errors are corrected (highlighted in the text). 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you very much for your submission. This is a nice study, which could set a nice ground for future research on prognosis and outcome of COVID-19. As a general comment, language and grammar needs revision. It does not deter from the possibility to understand the text, but there are multiple typos. I would also review the format. The tables could be reviewed and perhaps combined; the format could be made homogeneous. The resolution and quality of images should be reviewed . Authors’ Response: Thank you for your appreciation and your feedback. We have proofread the manuscript thoroughly and corrected grammatical errors (highlighted in manuscript). We have also reviewed the format of Table 2 and shortened it by removing 2 rows (listing frequencies and percentages of the individual initial and highest CXR-SS) which we feel were redundant. Moreover, we have ensured the resolution of the images is 1200 dpi and have used the PACE tool to make sure they are appropriate. We hope that it is adequate now. Reviewer #2: This is an high quality article and I appreciate a lot the paper. Only some minor suggestions: Discuss the possible role of ultrasound already in use in other infectious diseases ex tuberculosis and HIV (see and cite Bobbio F, Focused ultrasound to diagnose HIV-associated tuberculosis (FASH) in the extremely resource-limited setting of South Sudan: a cross-sectional study. BMJ Open. 2019 Apr 2;9(4):e027179. DOI: 10.1136/bmjopen-2018-027179. PMID: 30944140; PMCID: PMC6500283.) Figure 2 is not easy to read for the quality of image. Please add image with high quality Authors’ Response: Thank you for your appreciation and your feedback. We have added the suggested Reference in our Introduction, and discussed the role of ultrasound as well: “The use of ultrasound (US) has been explored previously in the diagnostics of other infectious diseases (2). Some studies have considered the emerging role of portable US imaging of the lungs in COVID-19 detection, describing ultrasound findings such as B-lines, consolidation and thickened pleural lines (3). However, US has its limitations, as it is highly operator-dependent and difficult to perform in patients with severe disease in an intensive care unit (ICU) set-up. Moreover, the specificity of ultrasound in patients with COVID-19 presenting with early disease has also proven to be significantly lower as compared to chest x-ray and computerized tomography scans (4)”. Additionally, we have ensured the resolution of the images is 1200 dpi and have used the PACE tool to make sure they are appropriate. We hope that it is adequate now. 1. Thank you for including your ethics statement on the online submission form: "For this retrospective study, ethical approval was obtained from the institutional review board of the Aga Khan University Hospital (Reference Number: 2020-4774-10611). We were granted a waiver of informed consent since it was retrospective study and all those patients were discharged from the hospital. Records were anonymised to the statistician and X-rays were anonymised to the radiographers as to the clinical condition of patient. ". To help ensure that the wording of your manuscript is suitable for publication, would you please also add this statement at the beginning of the Methods section of your manuscript file. Authors’ Response: Thank you. We have added the following to the first paragraph of our Methods section: “For this retrospective study, ethical approval was obtained from the institutional review board of the Aga Khan University Hospital (Reference Number: 2020-4774-10611). We were granted a waiver of informed consent as this was a retrospective study and all patients were discharged from the hospital. No personal identifiers were included in data collection, and records were anonymized to the statistician.”. We hope it is adequate. 2. Please ensure that you refer to Figure 1 in your text as, if accepted, production will need this reference to link the reader to the figure. Authors’ Response: Thank you. We have added the following to our Methods section: “An example of the application of this scoring system is shown in Figure 1.”. Attachments Attachment Submitted filename: Response Letter - PLOS.docx https://doi.org/10.1371/journal.pone.0244886.r002
18 Dec 2020 Decision Letter - Francesco Di Gennaro, Editor The Association of Chest Radiographic Findings and Severity Scoring with Clinical Outcomes in Patients with COVID-19 Presenting to the Emergency Department of a Tertiary Care Hospital in Pakistan PONE-D-20-24338R1 Dear Dr. Hilal, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Francesco Di Gennaro Academic Editor PLOS ONE Additional Editor Comments (optional): dear authors congratulations Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: Authors wrote an interesting article on a topic issue form interesting setting. I apprecciate this new version and in my opinion is suistable to publish in this present form ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No https://doi.org/10.1371/journal.pone.0244886.r003
Formally Accepted
26 Dec 2020 Acceptance Letter - Francesco Di Gennaro, Editor PONE-D-20-24338R1 The Association of Chest Radiographic Findings and Severity Scoring with Clinical Outcomes in Patients with COVID-19 Presenting to the Emergency Department of a Tertiary Care Hospital in Pakistan Dear Dr. Hilal: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Francesco Di Gennaro Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0244886.r004

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