Nayan Neelabh, Kumar M Krishna, Nair Ranjith K, Manral Ishita, Ghosh Snehasree, Bhalla Sharad, Singh Jasdeep, Monga Anuradha, Afzal Mohd, Kapoor Rajan
Department of Medicine, Command Hospital (Eastern Command), Alipore Road, Kolkata, West Bengal 700027 India.
Department of Anesthesia & Critical Care, Command Hospital, Kolkata, India.
SN Compr Clin Med. 2021;3(1):22-27. doi: 10.1007/s42399-020-00705-2. Epub 2021 Jan 7.
The importance of this study is the efficacy of "symptoms only" approach at a screening clinic for coronavirus disease 2019 (COVID-19) diagnosis in low- and middle-income countries (LMIC) setting. The objective of this study was to assess how efficiently primary care physicians at the screening clinic were able to predict whether a patient had COVID-19 or not, based on their symptom-based assessment alone. The current study is a cross-sectional retrospective observational study. This study was conducted at a single-center, tertiary care setting with a dedicated COVID-19 facility in a metropolitan city in eastern India. Participants are all suspected COVID-19 patients who presented themselves to this center during the outbreak from 1 August 2020 to 30 August 2020. Patients were referred to the Cough Clinic from the various outpatient departments of the hospital or from smaller satellite centers located in different parts of the city and other dependent geographical areas. The main outcome(s) and measure(s) is to study whether outcome of confirmatory test results can be predicted accurately by history taking alone. From 01 August 2020 to 30 Aug 2020, 511 patients with at least one symptom suggestive of COVID-19 reported to screening clinic. Out of these, 65.4% were males and 34.6% were females. Median age was 45 years with range being 01 to 92 years. Fever was seen in 70.4% while cough was present in 22% of cases. Overall positivity for SARS-CoV-2 during this period in this group was 54.21%. At 50% pre-test probability, the sensitivity of trained doctors working at the clinic, in predicting positive cases based on symptoms alone, was approximately 74.7%, and specificity for the same was 58.12%. The positive predictive value of the doctors' assessment was 67.87%, and the negative predictive value was 66.02%. Rapid triaging for confirmatory diagnosis of COVID-19 is feasible at screening clinic based on history taking alone by training of primary care physicians. This is particularly relevant in LMIC with scarce healthcare resources to overcome COVID-19 pandemic.
本研究的重要性在于在低收入和中等收入国家（LMIC）环境下，在一家筛查诊所采用“仅症状”方法进行2019冠状病毒病（COVID-19）诊断的有效性。本研究的目的是评估筛查诊所的初级保健医生仅基于症状评估能够多有效地预测患者是否感染COVID-19。当前研究是一项横断面回顾性观察研究。本研究在印度东部一个大都市的单中心三级医疗机构进行，该机构设有专门的COVID-19设施。研究对象为2020年8月1日至2020年8月30日疫情期间到该中心就诊的所有疑似COVID-19患者。患者从医院的各个门诊部或位于城市不同地区及其他相关地理区域的较小卫星中心转诊至咳嗽诊所。主要结局和指标是研究仅通过病史采集能否准确预测确诊检测结果。2020年8月1日至2020年8月30日，511例至少有一项提示COVID-19症状的患者到筛查诊所就诊。其中，男性占65.4%，女性占34.6%。年龄中位数为45岁，范围为1至92岁。70.4%的患者有发热症状，22%的患者有咳嗽症状。在此期间，该组中SARS-CoV-2的总体阳性率为54.21%。在50%的预测试概率下，在诊所工作的经过培训的医生仅基于症状预测阳性病例的敏感性约为74.7%，特异性为58.12%。医生评估的阳性预测值为67.87%，阴性预测值为66.02%。通过培训初级保健医生，仅基于病史采集在筛查诊所对COVID-19进行快速分诊以确诊是可行的。这在医疗资源稀缺的低收入和中等收入国家对于应对COVID-19大流行尤为重要。
