Correlation Between the COVID-19 Respiratory Triage Score and SARS-COV-2 PCR Test

Abstract

Background: COVID-19 clinical presentation is usually non-specific and includes commonly encountered symptoms like fever, cough, nausea, and vomiting. It has been reported that COVID-19 patients can potentially transmit the disease to others before developing symptoms. Thus, extensive surveillance and screening of individuals at risk of the disease is required to limit SARS-COV-2 spread. The COVID-19 respiratory triage score has been used for patient screening. We aimed to determine its diagnostic performance characteristics, which have not been adequately studied before.Methodology: This is a retrospective observational study involving all patients screened for COVID-19 at a tertiary care facility. Patients were tested using nasopharyngeal swab for SARS-COV-2 PCR. The Saudi CDC COVID-19 respiratory triage score was measured for all subjects. The sensitivity, specificity, positive predictive value, and negative predicted value of COVID-19 respiratory triage score were measured with reference to SARS-COV-2 PCR test. Multivariate regression analysis was done to identify factors that can predict a positive SARS-COV-2 PCR test.Result: A total of 1,435 subjects were included. The COVID-19 respiratory triage score provided a marginal diagnostic performance with a receiver-operating characteristics (ROC) area under the curve value of 0.60 (95% CI: 0.57–0.64). A triage score of 5 provided the best cut-off value for the combined sensitivity and specificity. Clinical characteristics that independently predicted positive COVID-19 PCR test include male sex (adjusted OR: 1.47; p = 0.034), healthcare workers and their family members (adjusted OR: 1.99; 95%; p = 0.016), fever (adjusted OR: 2.98; p < 0.001), and moderate disease severity (adjusted OR: 5; p < 0.001).Conclusion: The current COVID-19 respiratory triage score has marginal diagnostic performance characteristics. Its performance can improve by including additional predictors to the respiratory symptoms in order to avoid missing COVID-19 patients with atypical presentation and to limit unnecessary SARS-COV-2 PCR testing.

A systematic review of prediction models to diagnose COVID-19 in adults admitted to healthcare centers

“…All the models performed well to discriminate people with or without COVID-19 (all AUROCs> 0.500). The lowest AUROC was observed for the model of Aldobyany [ 12 ] (i.e., an AUROC of 0.600) and the best AUROC was that of the model of Kurstjens et al [ 21 ] (i.e., an AUROC of 0.940).…”

“…The final resulted models were either simple with as few variables as four (McDonald et al [ 22 ]) or complex with 15 variables (Plante et al [ 22 ]). To advance practical uses, authors also proposed scores [ 12 , 16 , 19 – 21 , 23 ] which eased the calculation process and facilitate clinical use. The nature of the predictors varied across studies (i.e., the included models incorporated different combinations of socio-demographics (age and gender), clinical symptoms, vital signs, laboratory or biological tests).…”

Real-world diagnostic value of a nationwide standardized COVID-19 triage chart in Turkey

“…Male sex, being a healthcare worker or their family member, and fever were predictive of PCR positivity. 22 Another similar triage study was conducted by Mansella et al, who reported that COVID-19 PCR positivity was significantly associated with symptoms such as fever, cough, myalgia, and headache; however, symptoms such as dyspnea, wheezing and sore throat have been reported as having a significant association with PCR negativity. 23 A risk tool developed by Lundon et al, which includes body mass index (BMI), age, gender, and temperature, had an AUC of 0.77 for COVID-19 positivity.…”

“…A Saudi Arabian study that evaluated the prediction of a positive PCR test using a triage chart reported that the sensitivity, specificity, positive predictive value, and negative predictive value were 64%, 55.7%, 31.1%, and 83.2%, respectively. 22 A ROC curve analysis reported AUC value of 0.60 (95% CI: [0.57; 0.64]). Male sex, being a healthcare worker or their family member, and fever were predictive of PCR positivity.…”

Predictive Ability of Factors in diagnosing COVID-19: Experiences from Qatar's Primary Care Settings

“…In developing the scoring system, the study took into consideration demographic data, clinical symptoms and health status. Other published studies evaluating performance of screening questionnaires did not use disease predictors included in this study and their combinations along with a scoring system ( Aldobyany et al 2020 , Ornaghi et al 2020 ). Furthermore, they were conducted in tertiary care settings.…”