ABSTRACT
Objective@#This rapid review aimed to summarize data on the accuracy, benefits, harms, and cost-effectiveness of preoperative COVID-19 clinical risk assessment for asymptomatic individuals. @*Methods@#A comprehensive search in MEDLINE, Cochrane CENTRAL, ChinaXiv, medRxiv, and bioRxiv was done until March 10, 2021, using the keywords “COVID-19”, “surgery”, “RT-PCR”, “clinical risk assessment” and “cost-effectiveness”. We searched for studies that assessed the diagnostic accuracy of preoperative clinical risk assessment in COVID-19 screening among asymptomatic individuals, its cost-effectiveness, and its impact on surgical outcomes and management decisions. Risk of bias was assessed using Evaluation of Articles on Diagnosis (Painless Evidence Based Medicine)10 for accuracy studies, Newcastle-Ottawa Scale11 for cohort studies, and Drummond’s checklist12 for economic evaluations. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the overall evidence. Data from included studies were collated qualitatively using summary tables and analyzed in Review Manager 5.4. Pooling of sensitivity and specificity, odds ratio or adjusted odds ratio, and cost-effectiveness measures using a random-effects model was planned. Heterogeneity was determined using I2. Subgroup and sensitivity analyses were preplanned in case significant heterogeneity was found. @*Results@#Three observational studies were included. Preoperative clinical risk assessment for COVID-19 demonstrated a sensitivity of 0.42 (95% CI 0.15-0.72) and a specificity of 0.85 (95% CI 0.76-0.92), using RT-PCR as a reference standard. Indirect evidence showed that any positive clinical risk assessment, COVID-19 antigen or RT-PCR test is done within 0–7 weeks from surgery was associated with a higher 30-day postoperative mortality (RR 3.96, 95% CI 3.41, 4.59) and pulmonary complications (RR 3.41, 95% CI 3.04, 3.83). Delaying surgery at least seven weeks from COVID-19 diagnosis was associated with lower post-surgical complications. Universal pre-endoscopy virus testing using the antigen rapid diagnostic test (Ag-RDT) (ICER = -26,286 €), standard RT-PCR (ICER = -11,128€), or rapid PCR (ICER = -13,703 €) combined with high-risk personal protective equipment (PPE) use in all patients irrespective of test results were found to be more cost-effective compared to no pre-endoscopy testing and no high-risk PPE use, at an, assumed COVID-19 prevalence of 1% or higher among asymptomatic individuals. Overall certainty of evidence was very low. @*Conclusion@#Preoperative clinical risk assessment has poor sensitivity but high specificity for detecting COVID-19 among asymptomatic individuals undergoing elective surgery. Objective diagnostic tests such as RT-PCR or Ag-RDT may still be needed to inform surgery schedules. @*@#
Subject(s)
COVID-19 , Mass ScreeningABSTRACT
Background@#Pooled testing has been implemented on a limited scale, mainly for screening and surveillance in populations with a low prevalence of COVID-19 to save on limited resources. @*Objective@#To determine the diagnostic accuracy of pooled compared with individual RT-PCR testing for SARS-CoV-2 in individuals suspected of COVID-19.@*Methods@#We searched websites of living CPGs on COVID-19 (Australian COVID-19, COVID NMA, CEBM Oxford), Philippine DOH HTA, databases (PubMed, CENTRAL, medRXIV/bioRXIV), and Clinicaltrials.gov for studies that used pooled testing on individuals suspected of COVID-19. When appropriate, we pooled data for sensitivity and specificity and obtained the range and median of other data, such as positive predictive value and resource savings. We did a priori subgroup analysis for pool size, presence or absence of symptoms and use case, type of specimen, cutoff for positivity, type of kit, and post hoc subgroup analysis for method of pooling and timing of processing. @*Results@#We included 21 studies: 6 diagnostic accuracy studies, and 15 clinical validation studies. Studies had varying populations, index test kit and performance characteristics, positivity rate (0.02 to 15%), and pool size (5 to 16). There was moderate pooled sensitivity, 81% (95% CI 72, 88; I2=73.6%; 6 studies, 776 pools) and high pooled specificity, 99% (95% CI, 98 to 100; I2=1.84%; 5 studies, 666 pools). Positive predictive value based on 21 studies ranged from 67% to 100%. Resource savings in the number of test kits used ranged from 49 to 89%. Identified harms of pooled testing were delayed turnaround time for positive samples and laboratory errors.@*Conclusion@#There is moderate sensitivity and high specificity with pooled testing for the screening of individuals with suspected COVID-19. We recommend further studies to validate the utility based on community prevalence and other test variables.
Subject(s)
COVID-19 , CoronavirusABSTRACT
@#One of the consequences of the COVID-19 pandemic is an avalanche of information that is unprecedented in magnitude. In the past 2 months, healthcare providers, policy-makers and the general public have been overwhelmed by this phenomenon. Aside from usual news from TV, radio, newspapers and medical journals, people from all walks of life have had to process kilometric threads on viber, facebook and twitter, as well as hundreds of issuances from all government agencies - from the Office of the President down to the barangays. The information from these various sources are often inconsistent or conflicting, and are always rapidly evolving. New information emerges as outdated information is just beginning to circulate. To aggravate the situation, the chaos is taken advantage of by perpetrators of false information. Clearly, this “informageddon” has led to “information overload” – the inability to process facts because of volume or pace. The manifestation is the widespread panic we are witnessing from all sectors of society. The consequence is impaired decision making – by individuals, families, communities and policy makers. Ultimately, this may lead to a prolonged, uncontrolled pandemic characterized by avoidable deaths, disability, and huge social and economic costs. Even healthcare providers are affected. Because of fear, many feel pressured to do tests and give treatments for COVID-19, that are poorly tested for effectiveness and safety. To help manage the information for policy-makers, healthcare workers and the general public, a group of 70 clinical epidemiologists and health professionals gathered together from the Institute of Clinical Epidemiology, National Institutes of Health-UP Manila and the Asia-Pacific Center for Evidence Based Healthcare Inc. The group conducted voluntary rapid evidence reviews and referred to themselves as “The Rappers”. The reviews were graciously shared by Philippine Society of Microbiology and Infectious Diseases through their website (PSMID.org). The online version allowed regular and rapid updates as evidence accrued.
Subject(s)
COVID-19 , CoronavirusABSTRACT
BACKGROUND AND OBJECTIVES: Acoustic analysis is an objective instrumental method that makes more accurate and reliable assessments of vocal characteristics possible. The aim of the current study was to describe the vocal characteristics of Filipinos with perceptually normal voices in terms of (1) fundamental frequency, (2) intensity, (3) frequency and intensity perturbations, (4) speaking fundamental frequency range, and (5) nasalance.METHODOLOGY: A total of 142 healthy adults aged 18 - 53 years participated in this study. The group was composed of 73 men (26.9 ± 6.4 years old) and 69 women (26.1 ± 6.5 years old). Voice samples were collected using Computerized Speech Laboratory (CSL; Model 4300B) during sustained phonation of vowel /a/ and spontaneous speech. Nasometer (Model 6200-3) was used to assess nasality while participants read plosive- and sibilant-loaded sentences.RESULTS AND CONCLUSION: The average acoustic values for males were F0 = 125.8 ± 23.4 Hz, SF0 = 122.6 ± 15.6 Hz, SF0 range = 85.8-269 Hz, SPL (speech) = 58.6 ± 5.3 dB, SPL (vowel) = 66.6 ± 6.2 dB, jitter = 0.92 ± 0.48%, shimmer = 2.21 ± 0.73%, nasalance = 12.5-17.1%; for females, F0 = 196.3 ± 23.0 Hz, SF0 = 194.8 ± 19.0 Hz, SF0 range = 97.1- 309.6Hz, SPL (speech) = 57.6 ± 4.3 dB, SPL (vowel) = 65.3 ± 4.5 dB, jitter = 1.12 ± 0.34%, shimmer = 2.7 ± 0.64%, nasalance = 13.1-19.1%. Significant differences were found between male and female subjects for F0, SF0, perturbation measures, and SPL during sustained phonation (p