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COVID-19 assessment in family practice-A clinical decision rule based on self-rated symptoms and contact history.
Schneider, Antonius; Rauscher, Katharina; Kellerer, Christina; Linde, Klaus; Kneissl, Frederike; Hapfelmeier, Alexander.
  • Schneider A; TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany. antonius.schneider@tum.de.
  • Rauscher K; TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany.
  • Kellerer C; TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany.
  • Linde K; TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany.
  • Kneissl F; TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany.
  • Hapfelmeier A; TUM School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Munich, Germany.
NPJ Prim Care Respir Med ; 31(1): 46, 2021 11 25.
Article in English | MEDLINE | ID: covidwho-1537315
ABSTRACT
The study aimed to evaluate the diagnostic accuracy of contact history and clinical symptoms and to develop decision rules for ruling-in and ruling-out SARS-CoV-2 infection in family practice. We performed a prospective diagnostic study. Consecutive inclusion of patients coming for COVID-PCR testing to 19 general practices. Contact history and self-reported symptoms served as index test. PCR testing of nasopharyngeal swabs served as reference standard. Complete data were available from 1141 patients, 605 (53.0%) female, average age 42.2 years, 182 (16.0%) COVID-PCR positive. Multivariable logistic regression showed highest odds ratios (ORs) for "contact with infected person" (OR 9.22, 95% CI 5.61-15.41), anosmia/ageusia (8.79, 4.89-15.95), fever (4.25, 2.56-7.09), and "sudden disease onset" (2.52, 1.55-4.14). Patients with "contact with infected person" or "anosmia/ageusia" with or without self-reported "fever" had a high probability of COVID infection up to 84.8%. Negative response to the four items "contact with infected person, anosmia/ageusia, fever, sudden disease onset" showed a negative predictive value (NPV) of 0.98 (95% CI 0.96-0.99). This was present in 446 (39.1%) patients. NPV of "completely asymptomatic," "no contact," "no risk area" was 1.0 (0.96-1.0). This was present in 84 (7.4%) patients. To conclude, the combination of four key items allowed exclusion of SARS-CoV-2 infection with high certainty. With the goal of 100% exclusion of SARS-CoV-2 infection to prevent the spread of SARS-CoV-2 to the population level, COVID-PCR testing could be saved only for patients with negative response in all items. The decision rule might also help for ruling-in SARS-CoV-2 infection in terms of rapid assessment of infection risk.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Limits: Adult / Female / Humans Language: English Journal: NPJ Prim Care Respir Med Year: 2021 Document Type: Article Affiliation country: S41533-021-00258-4

Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study / Risk factors Limits: Adult / Female / Humans Language: English Journal: NPJ Prim Care Respir Med Year: 2021 Document Type: Article Affiliation country: S41533-021-00258-4