Self-reported olfactory and gustatory dysfunction and psychophysical testing in screening for COVID-19: A systematic review and meta-analysis.

BACKGROUND: A substantial proportion of coronavirus disease-2019 (COVID-19) patients demonstrate olfactory and gustatory dysfunction (OGD). Self-reporting for OGD is widely used as a predictor of COVID-19. Although psychophysical assessment is currently under investigation in this role, the sensitivity of these screening tests for COVID-19 remains unclear. In this systematic review we assess the sensitivity of self-reporting and psychophysical tests for OGD. METHODS: A systematic search was performed on PubMed, EMBASE, and ClinicalTrials.gov from inception until February 16, 2021. Studies of suspected COVID-19 patients with reported smell or taste alterations were included. Data were pooled for meta-analysis. Sensitivity, specificity, and diagnostic odds ratio (DOR) were reported in the outcomes. RESULTS: In the 50 included studies (42,902 patients), self-reported olfactory dysfunction showed a sensitivity of 43.9% (95% confidence interval [CI], 37.8%-50.2%), a specificity of 91.8% (95% CI, 89.0%-93.9%), and a DOR of 8.74 (95% CI, 6.67-11.46) for predicting COVID-19 infection. Self-reported gustatory dysfunction yielded a sensitivity of 44.9% (95% CI, 36.4%-53.8%), a specificity of 91.5% (95% CI, 87.7%-94.3%), and a DOR of 8.83 (95% CI, 6.48-12.01). Olfactory psychophysical tests analysis revealed a sensitivity of 52.8% (95% CI, 25.5%-78.6%), a specificity of 88.0% (95% CI, 53.7%-97.9%), and a DOR of 8.18 (95% CI, 3.65-18.36). One study used an identification test for gustatory sensations assessment. CONCLUSION: Although demonstrating high specificity and DOR values, neither self-reported OGD nor unvalidated and limited psychophysical tests were sufficiently sensitive in screening for COVID-19. They were not suitable adjuncts in ruling out the disease.

Implementation of Interdisciplinary Province-Wide Webinar Series During the COVID-19 Pandemic by the Federation of Medical Specialists of Quebec (FMSQ): A Survey Study.

Objectives: COVID-19 has forced a transformation in continuing professional development (CPD), shifting to virtual platforms. We report the results of a rapidly-implemented COVID-19 online interdisciplinary CPD webinar series. We aimed to determine if this virtual approach for large-scale CPD was relevant, appreciated, and effective for specialist physicians in Quebec. Methods and Analysis: This was a retrospective descriptive online survey-based study. The weekly virtual educational webinars took place between March 3, 2020 to June 15, 2020, resulting in a total of 26 webinars over 16 weeks. The study included all individuals who attended any of the webinar sessions, namely specialist physicians and department chiefs. Number of participants and overall appreciation of webinar sessions were data points collected. Results: Across all webinars, there were 8,500 unique specialist physicians which comprises 80.7% of the entire specialist practicing population in Quebec. Of note, every medical and surgical specialty was represented by attendance in at least one session. In total, 27,504 evaluation forms were completed out of all the sessions, meaning a 78.4% response rate. In post-webinar surveys, 97.6% of respondents agreed or strongly agreed that the webinars were pertinent to their practice and 94.6% agreed or strongly agreed that the presentation met their continuing professional needs. Conclusions: This novel interdisciplinary COVID-19 webinar series is a successful and appreciated strategy to maintain CPD amidst a global pandemic. One year later, it has become a mainstay in our toolbox and we trust this unique model of large-scale interdisciplinary CPD via webinar sessions is useful in normal times as well as in times of crisis.

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals: A Systematic Review and Meta-analysis.

Importance: Approximately 5% to 15% of patients with COVID-19 require invasive mechanical ventilation (IMV) and, at times, tracheostomy. Details regarding the safety and use of tracheostomy in treating COVID-19 continue to evolve. Objective: To evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs). Data Sources: EMBASE (Ovid), Medline (Ovid), and Web of Science from January 1, 2020, to March 4, 2021. Study Selection: English-language studies investigating patients with COVID-19 who were receiving IMV and undergoing tracheostomy. Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search). All screening was performed by 2 reviewers (P.S. and M.L.). Overall, 156 studies underwent full-text review. Data Extraction and Synthesis: We performed data extraction in accordance with Meta-analysis of Observational Studies in Epidemiology guidelines. We used a random-effects model, and ROBINS-I was used for the risk-of-bias analysis. Main Outcomes and Measures: SARS-CoV-2 transmission between HCPs and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (ICU) discharge in patients with COVID-19 who underwent tracheostomy. Results: Of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies (20.3%) were included in the meta-analysis. A total of 4669 patients were included in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients). We found that in all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women. We found that 28 studies (40.6%) investigated either surgical tracheostomy or percutaneous dilatational tracheostomy. Overall, 3 of 58 studies (5.17%) identified a small subset of HCPs who developed COVID-19 that was associated with tracheostomy. Studies did not consistently report the number of HCPs involved in tracheostomy. Among the patients, early tracheostomy was associated with faster ICU discharge (mean difference, 6.17 days; 95% CI, -11.30 to -1.30), but no change in IMV weaning (mean difference, -2.99 days; 95% CI, -8.32 to 2.33) or decannulation (mean difference, -3.12 days; 95% CI, -7.35 to 1.12). There was no association between mortality or perioperative complications and type of tracheostomy. A risk-of-bias evaluation that used ROBINS-I demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching. There was notable heterogeneity in study reporting. Conclusions and Relevance: The findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies.

Ambient Noise Levels and Wireless Headsets for Communication in Aerosolizing Otolaryngology Surgery During COVID-19.

The objective of this short scientific communication is to describe and test a strategy to overcome communication barriers in coronavirus disease 2019 (COVID-19) era otolaryngology operating rooms. Thirteen endoscopic sinus surgeries, 4 skull base surgeries, and 1 tracheotomy were performed with powered air-purifying respirators. During these surgeries, surgical team members donned headsets with microphones linked via conference call. Noise measurements and survey responses were obtained and compared to pre-COVID-19 data. Noise was problematic and caused miscommunication as per 93% and 76% of respondents, respectively. Noise in COVID-19 era operating rooms was significantly higher compared to pre-COVID-19 era data (73.8 vs 70.2 decibels, P = .04). Implementation of this headset strategy significantly improved communication. Respondents with headsets were less likely to encounter communication problems (31% vs 93%, P < .001). Intraoperative measures to protect surgical team members during aerosolizing surgeries may impair communication. Linking team members via a conference call is a solution to improve communication.