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COVID-MATCH65-A prospectively derived clinical decision rule for severe acute respiratory syndrome coronavirus 2.
Trubiano, Jason A; Vogrin, Sara; Smibert, Olivia C; Marhoon, Nada; Alexander, Adrian A; Chua, Kyra Y L; James, Fiona L; Jones, Nicholas R L; Grigg, Sam E; Xu, Cecilia L H; Moini, Nasreen; Stanley, Sam R; Birrell, Michael T; Rose, Morgan T; Gordon, Claire L; Kwong, Jason C; Holmes, Natasha E.
  • Trubiano JA; Department of Infectious Diseases, Austin Health, Heidelberg, Australia.
  • Vogrin S; Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia.
  • Smibert OC; Department of Infectious Diseases and The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia.
  • Marhoon N; Department of Medicine (St Vincent's Hospital), University of Melbourne, Fitzroy, Australia.
  • Alexander AA; Department of Infectious Diseases, Austin Health, Heidelberg, Australia.
  • Chua KYL; Department of Infectious Diseases and The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia.
  • James FL; Data Analytics Research and Evaluation (DARE) Centre, Austin Health and University of Melbourne, Heidelberg, Australia.
  • Jones NRL; Department of General Medicine, Austin Health, Heidelberg, Australia.
  • Grigg SE; Department of Infectious Diseases, Austin Health, Heidelberg, Australia.
  • Xu CLH; Department of Infectious Diseases, Austin Health, Heidelberg, Australia.
  • Moini N; Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia.
  • Stanley SR; Department of General Medicine, Austin Health, Heidelberg, Australia.
  • Birrell MT; Department of Infectious Diseases, Austin Health, Heidelberg, Australia.
  • Rose MT; Department of Infectious Diseases, Austin Health, Heidelberg, Australia.
  • Gordon CL; Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia.
  • Kwong JC; Department of General Medicine, Austin Health, Heidelberg, Australia.
  • Holmes NE; Electronic Medical Record and Information and Communications Technology Services, Austin Health, Heidelberg, Australia.
PLoS One ; 15(12): e0243414, 2020.
Article in English | MEDLINE | ID: covidwho-969724
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ABSTRACT

OBJECTIVES:

We report on the key clinical predictors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and present a clinical decision rule that can risk stratify patients for COVID-19. DESIGN, PARTICIPANTS AND

SETTING:

A prospective cohort of patients assessed for COVID-19 at a screening clinic in Melbourne, Australia. The primary outcome was a positive COVID-19 test from nasopharyngeal swab. A backwards stepwise logistic regression was used to derive a model of clinical variables predictive of a positive COVID-19 test. Internal validation of the final model was performed using bootstrapped samples and the model scoring derived from the coefficients, with modelling performed for increasing prevalence.

RESULTS:

Of 4226 patients with suspected COVID-19 who were assessed, 2976 patients underwent SARS-CoV-2 testing (n = 108 SARS-CoV-2 positive) and were used to determine factors associated with a positive COVID-19 test. The 7 features associated with a positive COVID-19 test on multivariable analysis were COVID-19 patient exposure or international travel, Myalgia/malaise, Anosmia or ageusia, Temperature, Coryza/sore throat, Hypoxia-oxygen saturation < 97%, 65 years or older-summarized in the mnemonic COVID-MATCH65. Internal validation showed an AUC of 0.836. A cut-off of ≥ 1.5 points was associated with a 92.6% sensitivity and 99.5% negative predictive value (NPV) for COVID-19.

CONCLUSIONS:

From the largest prospective outpatient cohort of suspected COVID-19 we define the clinical factors predictive of a positive SARS-CoV-2 test. The subsequent clinical decision rule, COVID-MATCH65, has a high sensitivity and NPV for SARS-CoV-2 and can be employed in the pandemic, adjusted for disease prevalence, to aid COVID-19 risk-assessment and vital testing resource allocation.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Clinical Decision-Making / COVID-19 Nucleic Acid Testing / SARS-CoV-2 / COVID-19 / Models, Biological Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Oceania Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0243414

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Clinical Decision-Making / COVID-19 Nucleic Acid Testing / SARS-CoV-2 / COVID-19 / Models, Biological Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Oceania Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0243414