Proposed clinical indicators for efficient screening and testing for COVID-19 infection using Classification and Regression Trees (CART) analysis
| Autor: | Goundappa K. Balasubramani, Karen S. Clarke, Lloyd Clarke, Mary Patricia Nowalk, Theresa M. Sax, Richard K. Zimmerman, Todd M Bear, Heather Eng, Rachel Taber |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Cart 2019-20 coronavirus outbreak Adolescent Coronavirus disease 2019 (COVID-19) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 030231 tropical medicine Immunology Short Report Disease Computational biology Biology Article law.invention Young Adult 03 medical and health sciences COVID-19 Testing 0302 clinical medicine law Humans Mass Screening Immunology and Allergy 030212 general & internal medicine Aged Aged 80 and over Pharmacology classification trees SARS-CoV-2 Brief Report screening Decision Trees COVID-19 Middle Aged Regression Transmission (mechanics) symptoms Female |
| Zdroj: | Human Vaccines & Immunotherapeutics medRxiv article-version (VoR) Version of Record |
| ISSN: | 2164-554X 2164-5515 |
| DOI: | 10.1080/21645515.2020.1822135 |
| Popis: | The introduction and rapid transmission of SARS-CoV-2 in the United States resulted in methods to assess, mitigate, and contain the resulting COVID-19 disease derived from limited knowledge. Screening for testing has been based on symptoms typically observed in inpatients, yet outpatient symptoms may differ. Classification and regression trees recursive partitioning created a decision tree classifying participants into laboratory-confirmed cases and non-cases. Demographic and symptom data from patients ages 18–87 years enrolled from March 29–June 8, 2020 were included. Presence or absence of SARS-CoV-2 was the target variable. Of 832 tested, 77 (9.3%) tested positive. Cases significantly more often reported diarrhea (12 percentage points (PP)), fever (15 PP), nausea/vomiting (9 PP), loss of taste/smell (52 PP), and contact with a COVID-19 case (54 PP), but less frequently reported sore throat (−27 PP). The 4-terminal node optimal tree had sensitivity of 69%, specificity of 78%, positive predictive value of 20%, negative predictive value of 97%, and AUC of 76%. Among those referred for testing, negative responses to two questions could classify about half (49%) of tested persons with low risk for SARS-CoV-2 and would save limited testing resources. Outpatient symptoms of COVID-19 appear to be broader than the inpatient syndrome. Initial supplies of anticipated COVID-19 vaccines may be limited and administration of first such available vaccines may need to be prioritized for essential workers, the most vulnerable, or those likely to have a robust response to vaccine. Another priority group could be those not previously infected. Those who screen out of testing may be less likely to have been infected by SARS-CoV-2 virus thus may be prioritized for vaccination when supplies are limited. |
| Databáze: | OpenAIRE |
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