Accuracy of Emergency Department Clinical Findings for Diagnostic 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

doi:10.2139/ssrn.3598665

Cited by 4 publications

(3 citation statements)

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“…Moreover, the latest have been reliant on laboratory and imaging data, while a few models incorporating signs and symptoms have not been prospectively validated. [14][15][16][17][18][19] Our model includes symptoms and risk factors for COVID-19 infection that have been described as frequent among patients with COVID-19 infection. 7 However, none of these alone had a likelihood ratio that would allow crossing the testing threshold, except for anosmia or dysgeusia and an Volume 22, no.…”

Section: Discussionmentioning

confidence: 99%

Clinical Prediction Tool to Assess the Likelihood of a Positive SARS-Cov-2 (COVID-19) Polymerase Chain Reaction Test in Patients with Flu-like Symptoms

Lara¹,

Torres²,

Holger³

et al. 2021

WJEM

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Introduction The clinical presentation of coronavirus disease 2019 (COVID-19) overlaps with many other common cold and influenza viruses. Identifying patients with a higher probability of infection becomes crucial in settings with limited access to testing. We developed a prediction instrument to assess the likelihood of a positive polymerase chain reaction (PCR) test, based solely on clinical variables that can be determined within the time frame of an emergency department (ED) patient encounter. Methods We derived and prospectively validated a model to predict SARS-CoV-2 PCR positivity in patients visiting the ED with symptoms consistent with the disease. Results Our model was based on 617 ED visits. In the derivation cohort, the median age was 36 years, 43% were men, and 9% had a positive result. The median time to testing from the onset of initial symptoms was four days (interquartile range [IQR]: 2–5 days, range 0–23 days), and 91% of all patients were discharged home. The final model based on a multivariable logistic regression included a history of close contact (adjusted odds ratio [AOR] 2.47, 95% confidence interval [CI], 1.29–4.7); fever (AOR 3.63, 95% CI, 1.931–6.85); anosmia or dysgeusia (AOR 9.7, 95% CI, 2.72–34.5); headache (AOR 1.95, 95% CI, 1.06–3.58), myalgia (AOR 2.6, 95% CI, 1.39–4.89); and dry cough (AOR 1.93, 95% CI, 1.02–3.64). The area under the curve (AUC) from the derivation cohort was 0.79 (95% CI, 0.73–0.85) and AUC 0.7 (95% CI, 0.61–0.75) in the validation cohort (N = 379). Conclusion We developed and validated a clinical tool to predict SARS-CoV-2 PCR positivity in patients presenting to the ED to assist with patient disposition in environments where COVID-19 tests or timely results are not readily available.

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Section: Discussionmentioning

confidence: 99%

Clinical Prediction Tool to Assess the Likelihood of a Positive SARS-Cov-2 (COVID-19) Polymerase Chain Reaction Test in Patients with Flu-like Symptoms

Lara¹,

Torres²,

Holger³

et al. 2021

WJEM

View full text Add to dashboard Cite

show abstract

“…Benchoufi et al, 33 state that specificity was 83%, however, this was based on the LUS being simply normal or pathologic. Peyrony et al 36 achieved a slightly higher specificity of 89%, however, this was based on only the presence of bilateral B lines. A more nuanced LUS assessment may lead to greater specificity.…”

Section: Comparison Of Lus To a Reference Standardmentioning

confidence: 94%

“…In Peyrony et al, 36 47 patients presented to an ED with suspected COVID-19 and received LUS. The presence of bilateral B lines had a sensitivity and specificity of 77% and 89% respectively.…”

Section: Comparison Of Lus To a Reference Standard (Ct)mentioning

confidence: 99%

The utility of lung ultrasound in COVID-19: A systematic scoping review

et al. 2020

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Introduction Lung ultrasound (LUS) has an established evidence base and has proven useful in previous viral epidemics. An understanding of the utility of LUS in COVID-19 is crucial to determine its most suitable role based on local circumstances. Method Online databases, specialist websites and social media platforms were searched to identify studies that explore the utility of LUS in COVID-19. Case reports and recommendations were excluded. Findings In total, 33 studies were identified which represent a rapidly expanding evidence base for LUS in COVID-19. The quality of the included studies was relatively low; however, LUS certainly appears to be a highly sensitive and fairly specific test for COVID-19 in all ages and in pregnancy. Discussion There may be LUS findings and patterns that are relatively specific to COVID-19; however, specificity may also be influenced by factors such as disease severity, pre-existing lung disease, operator experience, disease prevalence and the reference standard. Conclusion LUS is almost certainly more sensitive than chest radiograph for COVID-19 and has several advantages over computed tomography and real-time polymerase chain reaction. High-quality research is needed into various aspects of LUS including: diagnostic accuracy in undifferentiated patients; triage and prognostication; monitoring progression and guiding interventions; the persistence of residual LUS findings; inter-observer agreement and the role of contrast-enhanced LUS.

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A new screening tool for SARS-CoV-2 infection based on self-reported patient clinical characteristics: the COV19-ID score

et al. 2022

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Background While several studies aimed to identify risk factors for severe COVID-19 cases to better anticipate intensive care unit admissions, very few have been conducted on self-reported patient symptoms and characteristics, predictive of RT-PCR test positivity. We therefore aimed to identify those predictive factors and construct a predictive score for the screening of patients at admission. Methods This was a monocentric retrospective analysis of clinical data from 9081 patients tested for SARS-CoV-2 infection from August 1 to November 30 2020. A multivariable logistic regression using least absolute shrinkage and selection operator (LASSO) was performed on a training dataset (60% of the data) to determine associations between self-reported patient characteristics and COVID-19 diagnosis. Regression coefficients were used to construct the Coronavirus 2019 Identification score (COV19-ID) and the optimal threshold calculated on the validation dataset (20%). Its predictive performance was finally evaluated on a test dataset (20%). Results A total of 2084 (22.9%) patients were tested positive to SARS-CoV-2 infection. Using the LASSO model, COVID-19 was independently associated with loss of smell (Odds Ratio, 6.4), fever (OR, 2.7), history of contact with an infected person (OR, 1.7), loss of taste (OR, 1.5), muscle stiffness (OR, 1.5), cough (OR, 1.5), back pain (OR, 1.4), loss of appetite (OR, 1.3), as well as male sex (OR, 1.05). Conversely, COVID-19 was less likely associated with smoking (OR, 0.5), sore throat (OR, 0.9) and ear pain (OR, 0.9). All aforementioned variables were included in the COV19-ID score, which demonstrated on the test dataset an area under the receiver-operating characteristic curve of 82.9% (95% CI 80.6%–84.9%), and an accuracy of 74.2% (95% CI 74.1%–74.3%) with a high sensitivity (80.4%, 95% CI [80.3%–80.6%]) and specificity (72.2%, 95% CI [72.2%–72.4%]). Conclusions The COV19-ID score could be useful in early triage of patients needing RT-PCR testing thus alleviating the burden on laboratories, emergency rooms, and wards.

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Accuracy of Emergency Department Clinical Findings for Diagnostic of Coronavirus Disease-2019

Cited by 4 publications

References 0 publications

Clinical Prediction Tool to Assess the Likelihood of a Positive SARS-Cov-2 (COVID-19) Polymerase Chain Reaction Test in Patients with Flu-like Symptoms

Clinical Prediction Tool to Assess the Likelihood of a Positive SARS-Cov-2 (COVID-19) Polymerase Chain Reaction Test in Patients with Flu-like Symptoms

The utility of lung ultrasound in COVID-19: A systematic scoping review

A new screening tool for SARS-CoV-2 infection based on self-reported patient clinical characteristics: the COV19-ID score

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