From, Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
the, Department of Biostatistics, University at Buffalo, Buffalo, NY, USA.
Acad Emerg Med. 2020 Jun;27(6):469-474. doi: 10.1111/acem.14009. Epub 2020 Jun 8.
Symptom criteria for COVID-19 testing of heath care workers (HCWs) limitations on testing availability have been challenging during the COVID-19 pandemic. An evidence-based symptom criteria for identifying HCWs for testing, based on the probability of positive COVID-19 test results, would allow for a more appropriate use of testing resources.
This was an observational study of outpatient COVID-19 testing of HCWs. Prior to testing, HCWs were asked about the presence of 10 symptoms. Their responses were then compared to their subsequent pharyngeal swab COVID-19 polymerase chain reaction test results. These data were used to derive and evaluate a symptom-based testing criteria.
A total of 961 HCWs were included in the analysis, of whom 225 (23%) had positive test results. Loss of taste or smell was the symptom with the largest positive likelihood ratio (3.33). Dry cough, regardless of the presence or absence of other symptoms, was the most sensitive (74%) and the least specific (32%) symptom. The existing testing criteria consisting of any combination of one or more of three symptoms (fever, shortness of breath, dry cough) was 93% sensitive and 9% specific (area unce the curve [AUC] = 0.63, 95% confidence interval [CI] = 0.59 to 0.67). The derived testing criteria consisting of any combination of one or more of two symptoms (fever, loss of taste or smell) was 89% sensitive and 48% specific (AUC = 0.75, 95% CI = 0.71 to 0.78). The hybrid testing criteria consisting of any combination of one or more of four symptoms (fever, shortness of breath, dry cough, loss of taste or smell) was 98% sensitive and 8% specific (AUC = 0.77, 95% CI = 0.73 to 0.80).
An evidence-based approach to COVID-19 testing that at least includes fever and loss of taste or smell should be utilized when determining which HCWs should be tested.
在 COVID-19 大流行期间，医疗保健工作者（HCW）的 COVID-19 检测症状标准受到了检测资源可用性的限制。基于 COVID-19 检测阳性结果的可能性，为识别 HCW 进行检测制定一个基于证据的症状标准，将有助于更合理地利用检测资源。
这是一项针对 HCW 门诊 COVID-19 检测的观察性研究。在检测前，HCW 被询问了 10 种症状的存在情况。然后将他们的回答与随后的咽拭子 COVID-19 聚合酶链反应检测结果进行比较。这些数据用于得出和评估一种基于症状的检测标准。
共有 961 名 HCW 纳入分析，其中 225 名（23%）检测结果为阳性。失去味觉或嗅觉是阳性似然比最大的症状（3.33）。干咳，无论是否存在其他症状，是最敏感（74%）和最不特异（32%）的症状。现有的检测标准由任意组合的一种或多种三种症状（发热、呼吸急促、干咳）组成，其敏感性为 93%，特异性为 9%（曲线下面积 [AUC]为 0.63，95%置信区间 [CI]为 0.59 至 0.67）。由任意组合的一种或多种两种症状（发热、味觉或嗅觉丧失）组成的检测标准的敏感性为 89%，特异性为 48%（AUC 为 0.75，95%CI 为 0.71 至 0.78）。由任意组合的一种或多种四种症状（发热、呼吸急促、干咳、味觉或嗅觉丧失）组成的混合检测标准的敏感性为 98%，特异性为 8%（AUC 为 0.77，95%CI 为 0.73 至 0.80）。
在确定哪些 HCW 应接受检测时，应利用基于证据的 COVID-19 检测方法，至少包括发热和味觉或嗅觉丧失。
