Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

• Published in: BMC infectious diseases Vol. 21; no. 1; p. 255
• Main Authors: Romero-Gameros, Carlos Alfonso, Colin-Martínez, Tania, Waizel-Haiat, Salomón, Vargas-Ortega, Guadalupe, Ferat-Osorio, Eduardo, Guerrero-Paz, José Alberto, Intriago-Alor, Marielle, López-Moreno, Mayra Alejandra, Cuevas-García, Carlos Fredy, Mendoza-Zubieta, Victoria, Martínez-Ordaz, Jose Luis, González-Virla, Baldomero
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11-03-2021; BioMed Central; BMC
• Subjects: Accuracy; Adult; Age; Anosmia; Anosmia - virology; Blood pressure; Coronaviruses; Cough; Cough - virology; COVID-19; COVID-19 - diagnosis; Cross-Sectional Studies; Decision making; Demographic variables; Diagnosis; Diagnostic accuracy; Diagnostic software; Dyspnea; Dyspnea - virology; Emergency medical care; Emergency medical services; Emergency response; Epidemiology; Evaluation; Female; Fever; Fever - virology; Gender; Headache - virology; Headaches; Humans; Infections; Infectious diseases; Male; Medical protocols; Medical research; Medicine, Experimental; Mexico; Middle Aged; Olfaction disorders; Oxygen content; Oxygen saturation; Pandemics; Physicians; Polymerase chain reaction; Positive predictive value; Prospective Studies; Regression analysis; Respiration; SARS-CoV-2; Sensitivity; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Symptom Assessment; Symptomatology; Variables; Viral diseases; Vital signs; Mexico; COVID-19; Symptomatology; SARS-CoV-2; Positive predictive value; Diagnostic accuracy
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-05930-1

The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection.
An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19.
A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28).
The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease.
Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082 .