Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019 - 02/10/20
, Carole Marbeuf-Gueye, MD b, Vy Truong, MD b, Marion Giroud, MD b, Clémentine Rivière, MD b, Khalil Khenissi, MD b, Léa Legay, MD b, Marie Simonetta, MD b, Arben Elezi, MD b, Alessandra Principe, MD b, Pierre Taboulet, MD b, Carl Ogereau, MD b, Mathieu Tourdjman, MD, MPH a, b, Sami Ellouze, MD, PhD b, Jean-Paul Fontaine, MD b
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Abstract |
Study objective |
We seek to describe the medical history and clinical findings of patients attending the emergency department (ED) with suspected coronavirus disease 2019 (COVID-19) and estimate the diagnostic accuracy of patients’ characteristics for predicting COVID-19.
Methods |
We prospectively enrolled all patients tested for severe acute respiratory syndrome coronavirus 2 by reverse-transcriptase polymerase chain reaction in our ED from March 9, 2020, to April 4, 2020. We abstracted medical history, physical examination findings, and the clinical probability of COVID-19 (low, moderate, and high) rated by emergency physicians, depending on their clinical judgment. We assessed diagnostic accuracy of these characteristics for COVID-19 by calculating positive and negative likelihood ratios.
Results |
We included 391 patients, of whom 225 had positive test results for severe acute respiratory syndrome coronavirus 2. Reverse-transcriptase polymerase chain reaction result was more likely to be negative when the emergency physician thought that clinical probability was low, and more likely to be positive when he or she thought that it was high. Patient-reported anosmia and the presence of bilateral B lines on lung ultrasonography had the highest positive likelihood ratio for the diagnosis of COVID-19 (7.58, 95% confidence interval [CI] 2.36 to 24.36; and 7.09, 95% CI 2.77 to 18.12, respectively). The absence of a high clinical probability determined by the emergency physician and the absence of bilateral B lines on lung ultrasonography had the lowest negative likelihood ratio for the diagnosis of COVID-19 (0.33, 95% CI 0.25 to 0.43; and 0.26, 95% CI 0.15 to 0.45, respectively).
Conclusion |
Anosmia, emergency physician estimate of high clinical probability, and bilateral B lines on lung ultrasonography increased the likelihood of identifying COVID-19 in patients presenting to the ED.
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| Please see page 406 for the Editor’s Capsule Summary of this article. |
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| Supervising editors: Michael Gottlieb, MD; Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: OP, SE, and J-PF were responsible for study conception and design. OP, CM-G, VT, MG, CR, KK, LL, MS, AE, AP, PT, CO, and SE were responsible for provision of study materials for patients. OP, CM-G, VT, MG, CR, and SE were responsible for collection and assembly of data. OP was responsible for data analysis and interpretation. OP, MT, and JPF were responsible for writing the article. All authors approved the final article. OP takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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Vol 76 - N° 4
P. 405-412 - octobre 2020 Retour au numéro
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