COVID-MATCH65—A prospectively derived clinical decision rule for severe acute respiratory syndrome coronavirus 2

Trubiano, Jason A; Vogrin, Sara; Smibert, Olivia C; Marhoon, Nada; Alexander, Adrian A; Chua, Kyra; James, Fiona; Jones, N.; Grigg, Samuel E; Xu, Cecilia L H; Moini, Nasreen; Stanley, Sam R; Birrell, Michael T; Rose, Morgan; Gordon, Claire L.; Kwong, Jason C; Holmes, Natasha E

doi:10.1371/journal.pone.0243414

Cited by 12 publications

(23 citation statements)

References 11 publications

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“…F COVID-MATCH65 Score is a clinical decision rule internally derived that has a high sensitivity (92.6%) and NPV (99.5%) for SARS-CoV-2 and can be used to aid COVID-19 risk assessment and resource allocation for SARS-CoV-2 diagnostics. The resulting score ranges from 1 to 6.5 points with score ≤ 1 representing low risk for a positive test (9). ▽ Time from symptoms presentation and study recruitment (days).…”

Section: Discussionmentioning

confidence: 99%

The Role of Immunological and Clinical Biomarkers to Predict Clinical COVID-19 Severity and Response to Therapy—A Prospective Longitudinal Study

et al. 2021

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BackgroundThe association of pro-inflammatory markers such as interleukin-6 (IL-6) and other biomarkers with severe coronavirus disease 2019 (COVID-19) is of increasing interest, however their kinetics, response to current COVID-related treatments, association with disease severity and comparison with other disease states associated with potential cytokine storm (CS) such as Staphylococcus aureus bacteraemia (SAB) are ill-defined.MethodsA cohort of 55 hospitalized SARS-CoV-2 positive patients was prospectively recruited – blood sampling was performed at baseline, post-treatment and hospital discharge. Serum IL-6, C-reactive protein (CRP) and other laboratory investigations were compared between treatment groups and across timepoints. Acute serum IL-6 and CRP levels were then compared to those with suspected COVID-19 (SCOVID) and age and sex matched patients with SAB and patients hospitalized for any non-infectious condition (NIC).ResultsIL-6 was elevated at admission in the SARS-CoV-2 cohort but at lower levels compared to matched SAB patients. Median (IQR) IL-6 at admission was 73.89 pg/mL (30.9, 126.39) in SARS-CoV-2 compared to 92.76 pg/mL (21.75, 246.55) in SAB (p=0.017); 12.50 pg/mL (3.06, 35.77) in patients with NIC; and 95.51 pg/mL (52.17, 756.67) in SCOVID. Median IL-6 and CRP levels decreased between admission and discharge timepoints. This reduction was amplified in patients treated with remdesivir and/or dexamethasone. CRP and bedside vital signs were the strongest predictors of COVID-19 severity.ConclusionsKnowledge of the kinetics of IL-6 did not offer enhanced predictive value for disease severity in COVID-19 over common investigations such as CRP and vital signs.

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Section: Discussionmentioning

confidence: 99%

The Role of Immunological and Clinical Biomarkers to Predict Clinical COVID-19 Severity and Response to Therapy—A Prospective Longitudinal Study

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…15,22 Other clinical prediction rules that were restricted to use of data available at the bedside have proposed three to 11 criteria in the rule, and all were derived on retrospective samples, but none have yet been tested for inter-rater reliability or diagnostic accuracy in an independently and retrospectively collected validation sample. [12][13][14][15][16] The CORC rule was designed for use in high-throughput areas where personnel could have access to a pulse oximeter and a thermometer, for example, in the triage area of the ED, but also possibly in intake areas for homeless shelters or extended-care facilities.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 10 , 11 Additionally, only a handful of studies have accompanied these SARS‐CoV‐2 prediction rules with specific cutoffs that represent low‐probability scenarios for which practitioners can forego diagnostic testing. 12 , 13 , 14 , 15 , 16 Fewer studies have examined the diagnostic accuracy of physician gestalt for SARS‐CoV‐2 infection. 17 , 18 The studies that have been published on prediction have been criticized for high bias, and none have undergone full stages of validation.…”

Section: Introductionmentioning

confidence: 99%

“…However, far fewer studies have reported structured prediction rules designed to estimate the pretest probability of SARS‐CoV‐2 at the bedside without the use of laboratory or radiological imaging 9–11 . Additionally, only a handful of studies have accompanied these SARS‐CoV‐2 prediction rules with specific cutoffs that represent low‐probability scenarios for which practitioners can forego diagnostic testing 12–16 . Fewer studies have examined the diagnostic accuracy of physician gestalt for SARS‐CoV‐2 infection 17,18 .…”

Section: Introductionmentioning

confidence: 99%

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Inter‐rater reliability and prospective validation of a clinical prediction rule for SARS‐CoV‐2 infection

Nevel

Kline

2021

Academic Emergency Medicine

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Objectives Accurate estimation of the risk of SARS‐CoV‐2 infection based on bedside data alone has importance to emergency department (ED) operations and throughput. The 13‐item CORC (COVID [or coronavirus] Rule‐out Criteria) rule had good overall diagnostic accuracy in retrospective derivation and validation. The objective of this study was to prospectively test the inter‐rater reliability and diagnostic accuracy of the CORC score and rule (score ≤ 0 negative, > 0 positive) and compare the CORC rule performance with physician gestalt. Methods This noninterventional study was conducted at an urban academic ED from February 2021 to March 2021. Two practitioners were approached by research coordinators and asked to independently complete a form capturing the CORC criteria for their shared patient and their gestalt binary prediction of the SARS‐CoV‐2 test result and confidence (0%–100%). The criterion standard for SARS‐CoV‐2 was from reverse transcriptase polymerase chain reaction performed on a nasopharyngeal swab. The primary analysis was from weighted Cohen's kappa and likelihood ratios (LRs). Results For 928 patients, agreement between observers was good for the total CORC score, κ = 0.613 (95% confidence interval [CI] = 0.579–0.646), and for the CORC rule, κ = 0.644 (95% CI = 0.591–0.697). The agreement for clinician gestalt binary determination of SARs‐CoV‐2 status was κ = 0.534 (95% CI = 0.437–0.632) with median confidence of 76% (first–third quartile = 66–88.5). For 425 patients who had the criterion standard, a negative CORC rule (both observers scored CORC < 0), the sensitivity was 88%, and specificity was 51%, with a negative LR (LR−) of 0.24 (95% CI = 0.10–0.50). Among patients with a mean CORC score of >4, the prevalence of a positive SARS‐CoV‐2 test was 58% (95% CI = 28%–85%) and positive LR was 13.1 (95% CI = 4.5–37.2). Clinician gestalt demonstrated a sensitivity of 51% and specificity of 86% with a LR− of 0.57 (95% CI = 0.39–0.74). Conclusion In this prospective study, the CORC score and rule demonstrated good inter‐rater reliability and reproducible diagnostic accuracy for estimating the pretest probability of SARs‐CoV‐2 infection.

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Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19

Struyf

Deeks

Dinnes

et al. 2021

Cochrane Database of Systematic Reviews

179

106

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Cochrane Database of Systematic ReviewsMost studies were conducted in hospital settings, so the results may not be entirely representative of primary care settings. The results do not apply to children or older adults specifically, and do not clearly di erentiate between disease severities.The results suggest that a single symptom or sign included in this review cannot accurately diagnose COVID-19. However, the presence of loss of taste or smell may serve as a red flag for the presence of the disease. The presence of high temperature or cough may also be useful to identify people who might have COVID-19. These symptoms may be useful to prompt further testing when they are present.Further research is needed to investigate combinations of symptoms and signs; and testing unselected populations, in primary care settings and in children and older adults. How up to date is this review?For this update of the review, the authors searched for studies published from January to July 2020.Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 (Review)

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COVID-MATCH65—A prospectively derived clinical decision rule for severe acute respiratory syndrome coronavirus 2

Cited by 12 publications

References 11 publications

The Role of Immunological and Clinical Biomarkers to Predict Clinical COVID-19 Severity and Response to Therapy—A Prospective Longitudinal Study

The Role of Immunological and Clinical Biomarkers to Predict Clinical COVID-19 Severity and Response to Therapy—A Prospective Longitudinal Study

Inter‐rater reliability and prospective validation of a clinical prediction rule for SARS‐CoV‐2 infection

Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19

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