Accuracy of Emergency Department clinical findings for diagnostic of coronavirus disease-2019
| Autor: | Sami Ellouze, Khalil Khenissi, Marion Giroud, Carl Ogereau, Pierre Taboulet, Arben Elezi, Vy Truong, Carole Marbeuf-Gueye, Olivier Peyrony, Clémentine Rivière, Léa Legay, Alessandra Principe, Mathieu Tourdjman, Marie Simonetta, Jean-Paul Fontaine |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Likelihood ratios in diagnostic testing Olfaction Disorders 0302 clinical medicine COVID-19 Testing 030212 general & internal medicine Prospective Studies Prospective cohort study Medical History Taking Lung clinical probability Ultrasonography lung ultrasound medicine.diagnostic_test Reverse Transcriptase Polymerase Chain Reaction Middle Aged Emergency Medicine Female France medicine.symptom Coronavirus Infections Emergency Service Hospital Covid-19 Adult medicine.medical_specialty Pneumonia Viral Anosmia Physical examination Article 03 medical and health sciences Betacoronavirus Internal medicine medicine Humans Medical history Pandemics Physical Examination Aged Probability business.industry Clinical Laboratory Techniques SARS-CoV-2 030208 emergency & critical care medicine Emergency department Emergency Department clinical findings medicine.disease Confidence interval Radiography Pneumonia business |
| Zdroj: | Annals of Emergency Medicine |
| ISSN: | 1097-6760 0196-0644 |
| Popis: | Study objective We seek to describe the medical history and clinical findings of patients attending the emergency department (ED) with suspected coronavirus disease 2019 (COVID-19) and estimate the diagnostic accuracy of patients' characteristics for predicting COVID-19. Methods We prospectively enrolled all patients tested for severe acute respiratory syndrome coronavirus 2 by reverse-transcriptase polymerase chain reaction in our ED from March 9, 2020, to April 4, 2020. We abstracted medical history, physical examination findings, and the clinical probability of COVID-19 (low, moderate, and high) rated by emergency physicians, depending on their clinical judgment. We assessed diagnostic accuracy of these characteristics for COVID-19 by calculating positive and negative likelihood ratios. Results We included 391 patients, of whom 225 had positive test results for severe acute respiratory syndrome coronavirus 2. Reverse-transcriptase polymerase chain reaction result was more likely to be negative when the emergency physician thought that clinical probability was low, and more likely to be positive when he or she thought that it was high. Patient-reported anosmia and the presence of bilateral B lines on lung ultrasonography had the highest positive likelihood ratio for the diagnosis of COVID-19 (7.58, 95% confidence interval [CI] 2.36 to 24.36; and 7.09, 95% CI 2.77 to 18.12, respectively). The absence of a high clinical probability determined by the emergency physician and the absence of bilateral B lines on lung ultrasonography had the lowest negative likelihood ratio for the diagnosis of COVID-19 (0.33, 95% CI 0.25 to 0.43; and 0.26, 95% CI 0.15 to 0.45, respectively). Conclusion Anosmia, emergency physician estimate of high clinical probability, and bilateral B lines on lung ultrasonography increased the likelihood of identifying COVID-19 in patients presenting to the ED. |
| Databáze: | OpenAIRE |
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