1. Identifying COVID-19 cases in outpatient settings
- Author
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Jue Tao Lim, Fong Seng Lim, Yi Ann Louis Chai, Yii Jen Lew, Meena Sundaram, Yinan Mao, Yinxiaohe Sun, Borame L Dickens, Mark I-Cheng Chen, Desmond Luan Seng Ong, Alexius S. E. Soh, Barnaby Edward Young, Yi-Roe Tan, Alex R. Cook, Glorijoy Shi En Tan, Kangwei Zeng, Tun-Linn Thein, and Franco Wong
- Subjects
Male ,Pediatrics ,Abdominal pain ,Multivariate analysis ,Epidemiology ,Rhinorrhea ,030204 cardiovascular system & hematology ,Logistic regression ,Severity of Illness Index ,0302 clinical medicine ,COVID-19 Testing ,Sore throat ,Ambulatory Care ,Odds Ratio ,030212 general & internal medicine ,respiratory symptoms ,Headache ,Pharyngitis ,Middle Aged ,Classification ,Infectious Diseases ,online tool ,Disease Progression ,Female ,medicine.symptom ,diagnosis model ,Adult ,Diarrhea ,medicine.medical_specialty ,Adolescent ,Fever ,Sensitivity and Specificity ,03 medical and health sciences ,Young Adult ,Ambulatory care ,Clinical Decision Rules ,Severity of illness ,medicine ,Humans ,Original Paper ,Receiver operating characteristic ,business.industry ,SARS-CoV-2 ,Patient Selection ,COVID-19 ,Odds ratio ,Myalgia ,Abdominal Pain ,Dyspnea ,Logistic Models ,Cough ,Case-Control Studies ,Multivariate Analysis ,business - Abstract
Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.
- Published
- 2021