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-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.

Identifying Existing Evidence to Potentially Develop a Machine Learning Diagnostic Algorithm for Cough in Primary Care Settings: Scoping Review

“…The included articles (for summarized results related to cough, refer to Multimedia Appendix 3 ) covered the following diagnoses: COPD, asthma, obstructive airway disease (OAD), influenza or influenza-like illness, respiratory tract infection (RTI), bronchial carcinoma (BC), community-acquired pneumonia, COVID-19, dyspepsia, gastroesophageal reflux disease (GERD), differential diagnosis of pulmonary embolism, heart failure, and adverse effects of angiotensin-converting enzyme (ACE) inhibitors. Of these studies, 10 were prospective studies (Vandevoorde et al [27], Freeman et al [30], Price et al [34], Eysink et al [38], Kable et al [39], Navarro-Marí et al [44], Thursky et al [45], Senn et al [46], Govaert et al [26], and Hollenz et al [59]), 8 were prospective cohort or diagnostic studies (Hamers et al [29], Schneider et al [37], Pescatore et al [40], Buffels et al [42], Schneider et al [53], Hippisley-Cox et al [54], Erkens et al [57], and Wallander et al [58]), 5 were cross-sectional studies (van Schayck et al [33], Melbye et al [36], Schneider et al [43], Kool et al [49], Hopstaken et al [52]), 4 were case-control studies (Haroon et al [35], Hamilton et al [55], Iyen-Omofoman et al [56], and Visser et al [60]), 2 were multicenter studies (Vrijhoef et al [32] and van Elden et al [47]), and 1 each was a descriptive (Thiadens et al [41]), retrospective (Nakanishi et al [51]), cohort (Geijer et al [28]), prospective case series (Bloom et al [50]), prospective, systematic sampling study (Sočan et al [48]) and comparative study (van Schayck et al…”

“…As far as COVID-19 is concerned, a significant association was found for the variable "dry cough" in patients with COVID-19 (OR 1.69, 95% CI 1.08-2.62). The PPV was 21%; the NPV was 86% [53].…”

“…Nevertheless, the predictive value might vary with years and the region where the infection occurs, as well as between children and adults [45,48] This could be related to different virus variants, for example. Only 1 included study reported on the COVID-19 infection [53]. Although it did predict the COVID-19-infection, a described clinical decision rule did not include cough.…”