1. Identifying COVID-19 cases in primary care settings
- Author
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Kangwei Zeng, Yinxiaohe Sun, Desmond Luan Seng Ong, Borame L Dickens, Fong Seng Lim, Glorijoy Shi En Tan, Barnaby Edward Young, Louis Yi Ann Chai, Alex R. Cook, Meena Sundaram, Jue Tao Lim, Mark I-Cheng Chen, Franco Wong, Yi-Roe Tan, Tun-Linn Thein, Yinan Mao, Alexius S. E. Soh, and Yii-Jen Lew
- Subjects
Abdominal pain ,medicine.medical_specialty ,Percentile ,Receiver operating characteristic ,business.industry ,Respiratory infection ,medicine.anatomical_structure ,Ambulatory care ,Emergency medicine ,Sore throat ,Medicine ,medicine.symptom ,business ,Prospective cohort study ,Nose - 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 SARS-CoV-2 positive cases and 564 controls, accounting for the time course of illness at point of assessment. Clinical differentiators of cases and controls were used to derive model-based risk scores. Significant symptoms included abdominal pain, cough, diarrhea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5°C 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, we firstly used leave-one-out cross-validation, which 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. Secondly, in a separate ongoing prospective study of 237 COVID-19 and 346 primary care patients presenting with symptoms of acute respiratory infection, the baseline model had a sensitivity of 0.57 and specificity of 0.89, and in retrospective notes review of 100 COVID-19 cases diagnosed in primary care, sensitivity was 0.56. A web-app based tool has been developed for easy implementation as an adjunct to laboratory testing to differentiate COVID-19 positive cases among patients presenting in outpatient settings.
- Published
- 2020
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