COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history

Abstract The study aimed to evaluate the diagnostic accuracy of contact history and clinical symptoms and to develop decision rules for ruling-in and ruling-out SARS-CoV-2 infection in family practice. We performed a prospective diagnostic study. Consecutive inclusion of patients coming for COVID-PC...

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Autores principales:	Antonius Schneider, Katharina Rauscher, Christina Kellerer, Klaus Linde, Frederike Kneissl, Alexander Hapfelmeier
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/52b7b7a02533422ba27ef0c0250c2b50
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spelling	oai:doaj.org-article:52b7b7a02533422ba27ef0c0250c2b502021-11-28T12:07:15ZCOVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history10.1038/s41533-021-00258-42055-1010https://doaj.org/article/52b7b7a02533422ba27ef0c0250c2b502021-11-01T00:00:00Zhttps://doi.org/10.1038/s41533-021-00258-4https://doaj.org/toc/2055-1010Abstract The study aimed to evaluate the diagnostic accuracy of contact history and clinical symptoms and to develop decision rules for ruling-in and ruling-out SARS-CoV-2 infection in family practice. We performed a prospective diagnostic study. Consecutive inclusion of patients coming for COVID-PCR testing to 19 general practices. Contact history and self-reported symptoms served as index test. PCR testing of nasopharyngeal swabs served as reference standard. Complete data were available from 1141 patients, 605 (53.0%) female, average age 42.2 years, 182 (16.0%) COVID-PCR positive. Multivariable logistic regression showed highest odds ratios (ORs) for “contact with infected person” (OR 9.22, 95% CI 5.61–15.41), anosmia/ageusia (8.79, 4.89–15.95), fever (4.25, 2.56–7.09), and “sudden disease onset” (2.52, 1.55–4.14). Patients with “contact with infected person” or “anosmia/ageusia” with or without self-reported “fever” had a high probability of COVID infection up to 84.8%. Negative response to the four items “contact with infected person, anosmia/ageusia, fever, sudden disease onset” showed a negative predictive value (NPV) of 0.98 (95% CI 0.96–0.99). This was present in 446 (39.1%) patients. NPV of “completely asymptomatic,” “no contact,” “no risk area” was 1.0 (0.96–1.0). This was present in 84 (7.4%) patients. To conclude, the combination of four key items allowed exclusion of SARS-CoV-2 infection with high certainty. With the goal of 100% exclusion of SARS-CoV-2 infection to prevent the spread of SARS-CoV-2 to the population level, COVID-PCR testing could be saved only for patients with negative response in all items. The decision rule might also help for ruling-in SARS-CoV-2 infection in terms of rapid assessment of infection risk.Antonius SchneiderKatharina RauscherChristina KellererKlaus LindeFrederike KneisslAlexander HapfelmeierNature PortfolioarticleDiseases of the respiratory systemRC705-779ENnpj Primary Care Respiratory Medicine, Vol 31, Iss 1, Pp 1-6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the respiratory system RC705-779
spellingShingle	Diseases of the respiratory system RC705-779 Antonius Schneider Katharina Rauscher Christina Kellerer Klaus Linde Frederike Kneissl Alexander Hapfelmeier COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history
description	Abstract The study aimed to evaluate the diagnostic accuracy of contact history and clinical symptoms and to develop decision rules for ruling-in and ruling-out SARS-CoV-2 infection in family practice. We performed a prospective diagnostic study. Consecutive inclusion of patients coming for COVID-PCR testing to 19 general practices. Contact history and self-reported symptoms served as index test. PCR testing of nasopharyngeal swabs served as reference standard. Complete data were available from 1141 patients, 605 (53.0%) female, average age 42.2 years, 182 (16.0%) COVID-PCR positive. Multivariable logistic regression showed highest odds ratios (ORs) for “contact with infected person” (OR 9.22, 95% CI 5.61–15.41), anosmia/ageusia (8.79, 4.89–15.95), fever (4.25, 2.56–7.09), and “sudden disease onset” (2.52, 1.55–4.14). Patients with “contact with infected person” or “anosmia/ageusia” with or without self-reported “fever” had a high probability of COVID infection up to 84.8%. Negative response to the four items “contact with infected person, anosmia/ageusia, fever, sudden disease onset” showed a negative predictive value (NPV) of 0.98 (95% CI 0.96–0.99). This was present in 446 (39.1%) patients. NPV of “completely asymptomatic,” “no contact,” “no risk area” was 1.0 (0.96–1.0). This was present in 84 (7.4%) patients. To conclude, the combination of four key items allowed exclusion of SARS-CoV-2 infection with high certainty. With the goal of 100% exclusion of SARS-CoV-2 infection to prevent the spread of SARS-CoV-2 to the population level, COVID-PCR testing could be saved only for patients with negative response in all items. The decision rule might also help for ruling-in SARS-CoV-2 infection in terms of rapid assessment of infection risk.
format	article
author	Antonius Schneider Katharina Rauscher Christina Kellerer Klaus Linde Frederike Kneissl Alexander Hapfelmeier
author_facet	Antonius Schneider Katharina Rauscher Christina Kellerer Klaus Linde Frederike Kneissl Alexander Hapfelmeier
author_sort	Antonius Schneider
title	COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history
title_short	COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history
title_full	COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history
title_fullStr	COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history
title_full_unstemmed	COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history
title_sort	covid-19 assessment in family practice—a clinical decision rule based on self-rated symptoms and contact history
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/52b7b7a02533422ba27ef0c0250c2b50
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COVID-19 assessment in family practice—A clinical decision rule based on self-rated symptoms and contact history

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