Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic

Alike W van der Velden; Milensu Shanyinde; Emily Bongard; Femke Böhmer; Slawomir Chlabicz; Annelies Colliers; Ana García-Sangenís; Lile Malania; Jozsef Pauer; Angela Tomacinschii; Ly-Mee Yu; Katherine Loens; Margareta Ieven; Theo J Verheij; Herman Goossens; Akke Vellinga; Christopher C Butler

doi:10.1080/13814788.2023.2270707

Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic

Alike W van der Velden^*
, Milensu Shanyinde
, Emily Bongard
, Femke Böhmer
, Slawomir Chlabicz
, Annelies Colliers
, Ana García-Sangenís
, Lile Malania
, Jozsef Pauer
, Angela Tomacinschii
, Ly-Mee Yu
, Katherine Loens
, Margareta Ieven
, Theo J Verheij
, Herman Goossens
, Akke Vellinga
, Christopher C Butler

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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.

Original language	English
Article number	2270707
Number of pages	9
Journal	European Journal of General Practice
Volume	29
Issue number	1
DOIs	https://doi.org/10.1080/13814788.2023.2270707
Publication status	Published - Dec 2023

Keywords

COVID-19
SARS-CoV-2
diagnostic accuracy
prediction
respiratory tract infection

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10.1080/13814788.2023.2270707Licence: CC BY-NC

Clinical diagnosis of SARS-CoV-2 infection An observational study of respiratory tract infection in primary care in the early phase of the pandemicFinal published version, 1.13 MBLicence: CC BY-NC

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van der Velden, A. W., Shanyinde, M., Bongard, E., Böhmer, F., Chlabicz, S., Colliers, A., García-Sangenís, A., Malania, L., Pauer, J., Tomacinschii, A., Yu, L.-M., Loens, K., Ieven, M., Verheij, T. J., Goossens, H., Vellinga, A., & Butler, C. C. (2023). Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic. European Journal of General Practice, 29(1), Article 2270707. https://doi.org/10.1080/13814788.2023.2270707

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title = "Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic",

abstract = "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.",

keywords = "COVID-19, SARS-CoV-2, diagnostic accuracy, prediction, respiratory tract infection",

author = "\{van der Velden\}, \{Alike W\} and Milensu Shanyinde and Emily Bongard and Femke B{\"o}hmer and Slawomir Chlabicz and Annelies Colliers and Ana Garc{\'i}a-Sangen{\'i}s and Lile Malania and Jozsef Pauer and Angela Tomacinschii and Ly-Mee Yu and Katherine Loens and Margareta Ieven and Verheij, \{Theo J\} and Herman Goossens and Akke Vellinga and Butler, \{Christopher C\}",

note = "Publisher Copyright: {\textcopyright} 2023 The Author(s). Published by Informa UK Limited, trading as Taylor \& Francis Group.",

year = "2023",

month = dec,

doi = "10.1080/13814788.2023.2270707",

language = "English",

volume = "29",

journal = "European Journal of General Practice",

issn = "1381-4788",

publisher = "Taylor and Francis Ltd.",

number = "1",

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van der Velden, AW, Shanyinde, M, Bongard, E, Böhmer, F, Chlabicz, S, Colliers, A, García-Sangenís, A, Malania, L, Pauer, J, Tomacinschii, A, Yu, L-M, Loens, K, Ieven, M, Verheij, TJ, Goossens, H, Vellinga, A & Butler, CC 2023, 'Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic', European Journal of General Practice, vol. 29, no. 1, 2270707. https://doi.org/10.1080/13814788.2023.2270707

Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic. / van der Velden, Alike W; Shanyinde, Milensu; Bongard, Emily et al.
In: European Journal of General Practice, Vol. 29, No. 1, 2270707, 12.2023.

Research output: Contribution to journal › Article › Academic › peer-review

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

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 - https://www.scopus.com/pages/publications/85174952621

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 -

Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic

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