{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T19:44:39Z","timestamp":1784317479589,"version":"3.55.0"},"reference-count":41,"publisher":"European Respiratory Society (ERS)","issue":"1","license":[{"start":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T00:00:00Z","timestamp":1603324800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["RFD: DRF-2018-11-ST2-037"],"award-info":[{"award-number":["RFD: DRF-2018-11-ST2-037"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2020,10,7]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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 radiography is recommended following community-acquired pneumonia; however, its utility in monitoring recovery from COVID-19 pneumonia remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a prospective single-centre observational cohort study. Patients hospitalised with severe COVID-19 pneumonia (admission duration \u226548\u2005h and oxygen requirement \u226540% or critical care admission) underwent face-to-face assessment at 4\u20136\u2005weeks post-discharge. The primary outcome was radiological resolution of COVID-19 pneumonitis (Radiographic Assessment of Lung Oedema score &lt;5). Secondary outcomes included clinical outcomes, symptom questionnaires, mental health screening (Trauma Screening Questionnaire, seven-item Generalised Anxiety Disorder assessment and nine-item Patient Health Questionnaire) and physiological testing (4-m gait speed (4MGS) and 1-min Sit-to-Stand (STS) tests).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>119 patients were assessed between June 3, 2020 and July 2, 2020 at median (interquartile range (IQR)) 61 (51\u201367)\u2005days post-discharge: mean\u00b1<jats:sc>sd<\/jats:sc>age 58.7\u00b114.4\u2005years, median (IQR) body mass index 30.0 (25.9\u201335.2)\u2005kg\u00b7m<jats:sup>\u22122<\/jats:sup>, 62% male and 70% ethnic minority. Despite radiographic resolution of pulmonary infiltrates in 87%, modified Medical Research Council Dyspnoea (breathlessness) scale grades were above pre-COVID-19 baseline in 44%, 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 (&lt;0.8\u2005m\u00b7s<jats:sup>\u22121<\/jats:sup>) in 38% and 35% desaturated by \u22654% during the STS test. Of 56 thoracic computed tomography scans performed, 75% demonstrated COVID-19-related interstitial and\/or airways disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Persistent symptoms, adverse mental health outcomes and physiological impairment are common 2\u2005months after severe COVID-19 pneumonia. Follow-up chest radiography is a poor marker of recovery; therefore, holistic face-to-face assessment is recommended to facilitate early recognition and management of post-COVID-19 sequelae.<\/jats:p><\/jats:sec>","DOI":"10.1183\/23120541.00655-2020","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T21:35:19Z","timestamp":1603402519000},"page":"00655-2020","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":97,"title":["Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia"],"prefix":"10.1183","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5245-9911","authenticated-orcid":false,"given":"Rebecca F.","family":"D'Cruz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4954-8339","authenticated-orcid":false,"given":"Michael D.","family":"Waller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicity","family":"Perrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9377-3077","authenticated-orcid":false,"given":"Jimstan","family":"Periselneris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1714-9963","authenticated-orcid":false,"given":"Sam","family":"Norton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3396-5541","authenticated-orcid":false,"given":"Laura-Jane","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Patrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0474-9671","authenticated-orcid":false,"given":"David","family":"Walder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amadea","family":"Heitmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Madula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"McNulty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9599-7418","authenticated-orcid":false,"given":"Patricia","family":"Macedo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Lyall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey","family":"Warwick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1230-2781","authenticated-orcid":false,"given":"James B.","family":"Galloway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2525-6291","authenticated-orcid":false,"given":"Surinder S.","family":"Birring","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irem","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3538-2451","authenticated-orcid":false,"given":"Caroline J.","family":"Jolley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"key":"2024101710563240000_7.1.00655-2020.1","unstructured":"World Health Organization . Timeline of WHO's response to COVID-19. 2020. www.who.int\/news-room\/detail\/29-06-2020-covidtimeline Date last accessed: July 10, 2020."},{"key":"2024101710563240000_7.1.00655-2020.2","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2024101710563240000_7.1.00655-2020.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2815"},{"key":"2024101710563240000_7.1.00655-2020.4","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.030205"},{"key":"2024101710563240000_7.1.00655-2020.5","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2283030726"},{"key":"2024101710563240000_7.1.00655-2020.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1011802"},{"key":"2024101710563240000_7.1.00655-2020.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022450"},{"key":"2024101710563240000_7.1.00655-2020.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-003-2004-8"},{"key":"2024101710563240000_7.1.00655-2020.9","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/S2215-0366(20)30308-4","article-title":"Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population","volume":"7","author":"Pierce","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"2024101710563240000_7.1.00655-2020.10","unstructured":"Johns Hopkins University and Medicine Coronavirus Resource Centre . COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). 2020. www.arcgis.com\/apps\/opsdashboard\/index.html#\/bda7594740fd40299423467b48e9ecf6 Date last accessed: August 7, 2020."},{"key":"2024101710563240000_7.1.00655-2020.11","unstructured":"British Thoracic Society . British Thoracic Society guidance on respiratory follow up of patients with a clinico-radiological diagnosis of COVID-19 pneumonia. 2020. www.brit-thoracic.org.uk\/document-library\/quality-improvement\/covid-19\/resp-follow-up-guidance-post-covid-pneumonia Date last accessed: July 6, 2020."},{"key":"2024101710563240000_7.1.00655-2020.12","unstructured":"NHS Health Research Authority . Defining research: do I need NHS REC review? 2020. www.hra-decisiontools.org.uk\/ethics Date last accessed: July 13, 2020."},{"key":"2024101710563240000_7.1.00655-2020.13","doi-asserted-by":"crossref","first-page":"e0152601","DOI":"10.1371\/journal.pone.0152601","article-title":"Prevalence and predictive value of dyspnea ratings in hospitalized patients: pilot studies","volume":"11","author":"Stevens","year":"2016","journal-title":"PLoS One"},{"key":"2024101710563240000_7.1.00655-2020.14","doi-asserted-by":"publisher","DOI":"10.1378\/chest.14-2506"},{"key":"2024101710563240000_7.1.00655-2020.15","unstructured":"Medical Research Council . Medical Research Council Dyspnoea scale. 1986. https:\/\/mrc.ukri.org\/research\/facilities-and-resources-for-researchers\/mrc-scales\/mrc-dyspnoea-scale-mrc-breathlessness-scale Date last accessed: June 5, 2020."},{"key":"2024101710563240000_7.1.00655-2020.16","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01494-2020"},{"key":"2024101710563240000_7.1.00655-2020.17","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"2024101710563240000_7.1.00655-2020.18","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"2024101710563240000_7.1.00655-2020.19","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.181.2.158"},{"key":"2024101710563240000_7.1.00655-2020.20","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.140.6.734"},{"key":"2024101710563240000_7.1.00655-2020.21","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00162712"},{"key":"2024101710563240000_7.1.00655-2020.22","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1007\/s00038-013-0504-z","article-title":"Population-based reference values for the 1-min sit-to-stand test","volume":"58","author":"Strassmann","year":"2013","journal-title":"Int J Public Health"},{"key":"2024101710563240000_7.1.00655-2020.23","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2017-211280"},{"key":"2024101710563240000_7.1.00655-2020.24","unstructured":"Intensive Care National Audit and Research Centre . ICNARC Report on COVID-19 in Critical Care; England, Wales and Northern Ireland, 25 September 2020. 2020. www.icnarc.org\/Our-Audit\/Audits\/Cmp\/Reports Date last accessed: September 28, 2020."},{"key":"2024101710563240000_7.1.00655-2020.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1985"},{"key":"2024101710563240000_7.1.00655-2020.26","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.jinf.2020.05.064","article-title":"A clinical risk score to identify patients with COVID-19 at high risk of critical care admission or death: an observational cohort study","volume":"81","author":"Galloway","year":"2020","journal-title":"J Infect"},{"key":"2024101710563240000_7.1.00655-2020.27","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1001\/jama.2020.13372","article-title":"Thrombosis in hospitalized patients with COVID-19 in a New York City health system","volume":"324","author":"Bilaloglu","year":"2020","journal-title":"JAMA"},{"key":"2024101710563240000_7.1.00655-2020.28","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/S2215-0366(20)30287-X","article-title":"Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study","volume":"7","author":"Varatharaj","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"2024101710563240000_7.1.00655-2020.29","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1001\/jama.2020.5394","article-title":"Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy","volume":"323","author":"Grasselli","year":"2020","journal-title":"JAMA"},{"key":"2024101710563240000_7.1.00655-2020.30","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00547-2020"},{"key":"2024101710563240000_7.1.00655-2020.31","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.12603"},{"key":"2024101710563240000_7.1.00655-2020.32","doi-asserted-by":"publisher","DOI":"10.4103\/ijri.IJRI_469_16"},{"key":"2024101710563240000_7.1.00655-2020.33","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S1473-3099(20)30086-4","article-title":"Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study","volume":"20","author":"Shi","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"2024101710563240000_7.1.00655-2020.34","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41413-020-0084-5","article-title":"Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study","volume":"8","author":"Zhang","year":"2020","journal-title":"Bone Res"},{"key":"2024101710563240000_7.1.00655-2020.35","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.bbi.2020.07.037","article-title":"Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors","volume":"89","author":"Gennaro Mazza","year":"2020","journal-title":"Brain Behav Immun"},{"key":"2024101710563240000_7.1.00655-2020.36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1787"},{"key":"2024101710563240000_7.1.00655-2020.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2006.05.007"},{"key":"2024101710563240000_7.1.00655-2020.38","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00131612"},{"key":"2024101710563240000_7.1.00655-2020.39","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01822-2020"},{"key":"2024101710563240000_7.1.00655-2020.40","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60096-2"},{"key":"2024101710563240000_7.1.00655-2020.41","unstructured":"European Respiratory Society . Recommendation from ERS Group 9.1 (Respiratory function technologists\/Scientists). Lung function testing during COVID-19 pandemic and beyond. 2020. https:\/\/ers.app.box.com\/s\/zs1uu88wy51monr0ewd990itoz4tsn2h Date last accessed: July 8, 2020."}],"container-title":["ERJ Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/23120541.00655-2020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T05:04:40Z","timestamp":1740373480000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/23120541.00655-2020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,22]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,2,8]]},"published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1183\/23120541.00655-2020"],"URL":"https:\/\/doi.org\/10.1183\/23120541.00655-2020","relation":{},"ISSN":["2312-0541"],"issn-type":[{"value":"2312-0541","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,22]]}}}