PT  - JOURNAL ARTICLE
AU  - Madeline A DiLorenzo
AU  - Megan R Davis
AU  - Julianne N Dugas
AU  - Kerrie P Nelson
AU  - Natasha S Hochberg
AU  - Robin R Ingalls
AU  - Rebecca Grochow Mishuris
AU  - Elissa M Schechter-Perkins
TI  - Performance of three screening tools to predict COVID-19 positivity in emergency department patients
AID  - 10.1136/emermed-2021-212102
DP  - 2023 Mar 01
TA  - Emergency Medicine Journal
PG  - 210--215
VI  - 40
IP  - 3
4099  - http://emj.bmj.com/content/40/3/210.short
4100  - http://emj.bmj.com/content/40/3/210.full
SO  - Emerg Med J2023 Mar 01; 40
AB  - Background COVID-19 symptoms vary widely. This retrospective study assessed which of three clinical screening tools—a nursing triage screen (NTS), an ED review of systems (ROS) performed by physicians and physician assistants and a standardised ED attending (ie, consultant) physician COVID-19 probability assessment (PA)—best identified patients with COVID-19 on a subsequent reverse transcription PCR (RT-PCR) confirmation.Methods All patients admitted to Boston Medical Center from the ED between 27 April 2020 and 17 May 2020 were included. Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were calculated for each method. Logistic regression assessed each tool’s performance.Results The attending physician PA had higher sensitivity (0.62, 95% CI 0.53 to 0.71) than the NTS (0.46, 95% CI 0.37 to 0.56) and higher specificity (0.76, 95% CI 0.72 to 0.80) than the NTS (0.71, 95% CI 0.66 to 0.75) and ED ROS (0.62, 95% CI 0.58 to 0.67). Categorisation as moderate or high probability on the ED physician PA was associated with the highest odds of having COVID-19 in regression analyses (adjusted OR=4.61, 95% CI 3.01 to 7.06). All methods had a low PPV (ranging from 0.26 for the ED ROS to 0.40 for the attending physician PA) and a similar NPV (0.84 for both the NTS and the ED ROS, and 0.89 for the attending physician PA).Conclusion The ED attending PA had higher sensitivity and specificity than the other two methods, but none was accurate enough to replace a COVID-19 RT-PCR test in a clinical setting where transmission control is crucial. Therefore, we recommend universal COVID-19 testing prior to all admissions.No data are available.