Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019

Peyrony, Olivier; Marbeuf-Gueye, Carole; Truong, Vy; Giroud, Marion; Rivière, Clémentine; Khenissi, Khalil; Legay, Léa; Simonetta, Marie; Elezi, Arben; Principe, Alessandra; Taboulet, P.; Ogereau, Carl; Tourdjman, Mathieu; Ellouze, Sami; Fontaine, Jean-Paul

doi:10.1016/j.annemergmed.2020.05.022

Cited by 71 publications

(76 citation statements)

References 34 publications

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“…Less common symptoms included sputum production, headache , haemoptysis and diarrhea [3][4][5][6][7][8] . Further on, anosmia and ageusia also emerged as prevalent and relatively discriminative symptoms of COVID-19 infection [9][10][11][12] . As clinical data started to accumulate, reviews describing the potential cardiovascular 13 , gastrointestinal 14 , neurological 15 and cutaneous manifestations 16 of the disease were published.…”

Section: Introductionmentioning

confidence: 96%

Longitudinal symptom dynamics of COVID-19 infection in primary care

Mizrahi

Shilo

Rossman

et al. 2020

Preprint

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Importance: Data regarding the clinical characteristics of COVID-19 infection is rapidly accumulating. However, most studies thus far are based on hospitalized patients and lack longitudinal follow up. As the majority of COVID-19 cases are not hospitalized, prospective studies of symptoms in the population presenting to primary care are needed. Objective: To assess the longitudinal dynamic of clinical symptoms in non-hospitalized individuals prior to and throughout the diagnosis of SARS-CoV-2 infection. Design, Setting, and Participants: From 1/3/2020 to 07/06/2020, information on symptoms from either surveys or primary care visits was available for 206,377 individuals, including 2,471 who tested positive for COVID-19. Data were extracted from electronic health records (EHR) of the second largest Health Maintenance Organization in Israel, consisting of both results of PCR tests and symptoms recorded by primary care physicians, and linked longitudinal self reported symptoms. Exposures: Diagnosis of COVID-19 disease was made by PCR testing for SARS-CoV-2 from nasopharyngeal swabs. Main Outcomes and Measures: Longitudinal prevalence of clinical symptoms Results: In adults, the most prevalent symptoms recorded in EHR were cough (11.6%), fever (10.3%), and myalgia (7.7%) and the most prevalent self-reported symptoms were cough (21%), fatigue (19%) and rhinorrhea and/or nasal congestion (17%). In children, the most prevalent symptoms recorded in the EHR were fever (7%), cough (5.5%) and abdominal pain (2.4%). Emotional disturbances were documented in 15.9% of the positive adults and 4.2% of the children. Loss of taste and smell, either self-reported or documented by a physician, 3 weeks prior to testing, were the most discriminative symptoms in adults (OR =11.18 and OR=5.47 respectively). Additional symptoms included self reported confusion (OR =4.02), and fatigue (OR = 1.73) and a documentation of syncope, rhinorrhea (OR = 2.09 for both ) and fever (OR= 1.62 ) by a physician. Mean time to recovery was 23.5 +- 9.9 days. Children had a significantly shorter disease duration (21.7 +- 8.8 days, p-value=0.01). Several symptoms, including fatigue, myalgia, runny nose and shortness of breath were reported weeks after recovery. Conclusions and Relevance: As the COVID-19 pandemic progresses rapidly worldwide, obtaining accurate information on symptoms and their progression is of essence. Our study shed light on the full clinical spectrum of symptoms experienced by infected individuals in primary care, and may alert physicians for the possibility of COVID-19 infection.

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Section: Introductionmentioning

confidence: 96%

Longitudinal symptom dynamics of COVID-19 infection in primary care

Mizrahi

Shilo

Rossman

et al. 2020

Preprint

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“…4 Previously reported pulmonary manifestations of COVID-19 with POCUS include B-lines, subpleural consolidations, pleural thickening, and absence of pleural effusions. [4][5][6][7][8] POCUS has been proposed to aid in the diagnosis of COVID-19, 9 as well as to predict intensive care unit (ICU) admission or death. 10 Given the potential for POCUS to predict outcomes among COVID-19 patients, there is a significant need to determine if these findings can be reliably interpreted among providers.…”

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confidence: 99%

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Kumar

Weng

Graglia

et al. 2020

Preprint

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Background: Lung ultrasound (LUS) may be used in the diagnostic evaluation of patients with COVID-19. An abnormal LUS is associated with increased risk for ICU admission in COVID-19. Previously described LUS manifestations for COVID-19 include B-lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID-19 is unknown. Research Question: What is the interrater reliability of lung ultrasound findings in patients with RT-PCR confirmed COVID-19? Study Design and Methods: This study was conducted at conducted at two academic medical centers between 03/2020-06/2020. Nine physicians (hospitalists: n=4; emergency medicine: n=5) independently evaluated n=20 LUS scans (n=180 independent observations) collected from RT-PCR confirmed COVID-19 patients. These studies were randomly selected from an image database consisting of COVID-19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values were used to calculate IRR. Results: There was substantial IRR on the following items: normal LUS scan (K=0.79 [95% CI: 0.72-0.87]), presence of B-lines (K=0.79 [95% CI: 0.72-0.87]), >=3 B-lines observed (K=0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (K=0.57 [95% CI: 0.50-0.64]), subpleural consolidation (K=0.49 [95% CI: 0.42-0.56]), and presence of effusion (K=0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (K=0.23 [95% CI: 0.15-0.30]). Interpretation: Many LUS manifestations for COVID-19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID-19 may include the presence/count of B-lines or determining if a scan is normal. Clinical protocols for LUS with COVID-19 may require additional observers for the confirmation of less reliable findings such as consolidations.

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“…(15)(16)(17) However, the results of the studies published as of today are inconclusive, partly because of their great heterogeneity. (8) Peyrony et al (18) carried out a prospective observational study in a French hospital involving 391 patients, out of whom 225 (57.66%) tested positive for SARS-CoV-2 by RT-PCR. In this group, 53 (23.6%) presented gastrointestinal symptoms such as vomiting, diarrhea, or abdominal pain; 147 (65.6%) had a temperature below 38°C and 97 (43.3%) below 37.5°C upon arrival at the emergency department.…”

Section: Discussionmentioning

confidence: 99%

“…(31) Another limitation was not including gastrointestinal symptoms and taste alterations, which have been reported in other studies. (18,32) More prospective studies regarding the symptomatology associated to COVID-19, that weigh in the symptomatology strategy in the diagnosis of the disease, are required.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients 

Romero‐Gameros

Colin-Martínez

Waizel‐Haiat

et al. 2020

Preprint

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Background: The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection.Methods: An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19.Results: A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥ 2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28).Conclusion: The combination of symptoms associated with SARS-CoV-2 infection results in a highly predictive model for a rapid and accurate diagnosis of the disease, in the absence of auxiliary diagnostic studies. Evaluating the symptoms in isolation and in combination could be an appropriate strategy to be used in the emergency services to guide behavior in the face of the disease.Trial registration: Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

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Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019

Cited by 71 publications

References 34 publications

Longitudinal symptom dynamics of COVID-19 infection in primary care

Longitudinal symptom dynamics of COVID-19 infection in primary care

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

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Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019

Cited by 71 publications

References 34 publications

Longitudinal symptom dynamics of COVID-19 infection in primary care

Longitudinal symptom dynamics of COVID-19 infection in primary care

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients&nbsp;

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Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients