RT Journal Article
SR Electronic
T1 Performance of three screening tools to predict COVID-19 positivity in emergency department patients
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 210
OP 215
DO 10.1136/emermed-2021-212102
VO 40
IS 3
A1 Madeline A DiLorenzo
A1 Megan R Davis
A1 Julianne N Dugas
A1 Kerrie P Nelson
A1 Natasha S Hochberg
A1 Robin R Ingalls
A1 Rebecca Grochow Mishuris
A1 Elissa M Schechter-Perkins
YR 2023
UL http://emj.bmj.com/content/40/3/210.abstract
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.