TY - JOUR
T1 - Clinical diagnosis of SARS-CoV-2 infection
T2 - An observational study of respiratory tract infection in primary care in the early phase of the pandemic
AU - van der Velden, Alike W
AU - Shanyinde, Milensu
AU - Bongard, Emily
AU - Böhmer, Femke
AU - Chlabicz, Slawomir
AU - Colliers, Annelies
AU - García-Sangenís, Ana
AU - Malania, Lile
AU - Pauer, Jozsef
AU - Tomacinschii, Angela
AU - Yu, Ly-Mee
AU - Loens, Katherine
AU - Ieven, Margareta
AU - Verheij, Theo J
AU - Goossens, Herman
AU - Vellinga, Akke
AU - Butler, Christopher C
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2023/12
Y1 - 2023/12
N2 - BACKGROUND: Early in the COVID-19 pandemic, GPs had to distinguish SARS-CoV-2 from other aetiologies in patients presenting with respiratory tract infection (RTI) symptoms on clinical grounds and adapt management accordingly.OBJECTIVES: To test the diagnostic accuracy of GPs' clinical diagnosis of a SARS-CoV-2 infection in a period when COVID-19 was a new disease. To describe GPs' management of patients presenting with RTI for whom no confirmed diagnosis was available. To investigate associations between patient and clinical features with a SARS-CoV-2 infection.METHODS: In April 2020-March 2021, 876 patients (9 countries) were recruited when they contacted their GP with symptoms of an RTI of unknown aetiology. A swab was taken at baseline for later analysis. Aetiology (PCR), diagnostic accuracy of GPs' clinical SARS-CoV-2 diagnosis, and patient management were explored. Factors related to SARS-CoV-2 infection were determined by logistic regression modelling.RESULTS: GPs suspected SARS-CoV-2 in 53% of patients whereas 27% of patients tested positive for SARS-CoV-2. True-positive patients (23%) were more intensively managed for follow-up, antiviral prescribing and advice than true-negatives (42%). False negatives (5%) were under-advised, particularly for social distancing and isolation. Older age (OR: 1.02 (1.01-1.03)), male sex (OR: 1.68 (1.16-2.41)), loss of taste/smell (OR: 5.8 (3.7-9)), fever (OR: 1.9 (1.3-2.8)), muscle aches (OR: 2.1 (1.5-3)), and a known risk factor for COVID-19 (travel, health care worker, contact with proven case; OR: 2.7 (1.8-4)) were predictive of SARS-CoV-2 infection. Absence of loss of taste/smell, fever, muscle aches and a known risk factor for COVID-19 correctly excluded SARS-CoV-2 in 92.3% of patients, whereas presence of 3, or 4 of these variables correctly classified SARS-CoV-2 in 57.7% and 87.1%.CONCLUSION: Correct clinical diagnosis of SARS-CoV-2 infection, without POC-testing available, appeared to be complicated.
AB - BACKGROUND: Early in the COVID-19 pandemic, GPs had to distinguish SARS-CoV-2 from other aetiologies in patients presenting with respiratory tract infection (RTI) symptoms on clinical grounds and adapt management accordingly.OBJECTIVES: To test the diagnostic accuracy of GPs' clinical diagnosis of a SARS-CoV-2 infection in a period when COVID-19 was a new disease. To describe GPs' management of patients presenting with RTI for whom no confirmed diagnosis was available. To investigate associations between patient and clinical features with a SARS-CoV-2 infection.METHODS: In April 2020-March 2021, 876 patients (9 countries) were recruited when they contacted their GP with symptoms of an RTI of unknown aetiology. A swab was taken at baseline for later analysis. Aetiology (PCR), diagnostic accuracy of GPs' clinical SARS-CoV-2 diagnosis, and patient management were explored. Factors related to SARS-CoV-2 infection were determined by logistic regression modelling.RESULTS: GPs suspected SARS-CoV-2 in 53% of patients whereas 27% of patients tested positive for SARS-CoV-2. True-positive patients (23%) were more intensively managed for follow-up, antiviral prescribing and advice than true-negatives (42%). False negatives (5%) were under-advised, particularly for social distancing and isolation. Older age (OR: 1.02 (1.01-1.03)), male sex (OR: 1.68 (1.16-2.41)), loss of taste/smell (OR: 5.8 (3.7-9)), fever (OR: 1.9 (1.3-2.8)), muscle aches (OR: 2.1 (1.5-3)), and a known risk factor for COVID-19 (travel, health care worker, contact with proven case; OR: 2.7 (1.8-4)) were predictive of SARS-CoV-2 infection. Absence of loss of taste/smell, fever, muscle aches and a known risk factor for COVID-19 correctly excluded SARS-CoV-2 in 92.3% of patients, whereas presence of 3, or 4 of these variables correctly classified SARS-CoV-2 in 57.7% and 87.1%.CONCLUSION: Correct clinical diagnosis of SARS-CoV-2 infection, without POC-testing available, appeared to be complicated.
KW - COVID-19
KW - SARS-CoV-2
KW - diagnostic accuracy
KW - prediction
KW - respiratory tract infection
UR - http://www.scopus.com/inward/record.url?scp=85174952621&partnerID=8YFLogxK
U2 - 10.1080/13814788.2023.2270707
DO - 10.1080/13814788.2023.2270707
M3 - Article
C2 - 37870070
SN - 1381-4788
VL - 29
JO - European Journal of General Practice
JF - European Journal of General Practice
IS - 1
M1 - 2270707
ER -