Savoy Mona, Kopp Benoît, Chaouch Aziz, Cohidon Christine, Gouveia Alexandre, Lombardo Patrick, Maeder Muriel, Payot Sylvie, Perdrix Jean, Schwarz Joëlle, Senn Nicolas, Mueller Yolanda
Department of Ambulatory Care, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1011 Lausanne, Switzerland.
Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland.
Infect Dis Rep. 2023 Feb 10;15(1):112-124. doi: 10.3390/idr15010012.
This study aimed to estimate the diagnostic performance of patient symptoms and to describe the clinical course of RT-PCR-positive compared with RT-PCR-negative patients in primary care. Symptomatic COVID-19 suspects were assessed clinically at the initial consultation in primary care between March and May 2020, followed by phone consultations over a span of at least 28 days. Sensitivity and specificity were estimated for each symptom using the initial RT-PCR result as a reference standard. The proportions of symptomatic patients according to the RT-PCR test results were compared over time, and time to recovery was estimated. Out of 883 patients, 13.9% had a positive RT-PCR test, and 17.4% were not tested. Most sensitive symptoms were cough, myalgia, and a history of fever, while most specific symptoms were fever for ≥4 days, hypo/anosmia, and hypo/ageusia. At the final follow up (median time 55 days, range 28-105 days), 44.7% of patients still reported symptoms in the RT-PCR-positive group, compared with 18.3% in the negative group ( < 0.001), mostly with hypo/anosmia (16.3%), dyspnea (12.2%), and fatigue (10.6%). The discriminative value of individual symptoms for diagnosing COVID-19 was limited. Almost half of the SARS-CoV-2-positive patients still reported symptoms at least 28 days after the initial consultation.
本研究旨在评估患者症状的诊断效能，并描述初级保健中RT-PCR检测呈阳性与RT-PCR检测呈阴性的患者的临床病程。有症状的COVID-19疑似患者于2020年3月至5月在初级保健的首次会诊时接受临床评估，随后在至少28天的时间内进行电话会诊。以初始RT-PCR结果作为参考标准，对每种症状的敏感性和特异性进行评估。比较有症状患者根据RT-PCR检测结果随时间的比例，并估计恢复时间。在883名患者中，13.9%的患者RT-PCR检测呈阳性，17.4%的患者未接受检测。最敏感的症状是咳嗽、肌痛和发热史，而最具特异性的症状是发热≥4天、嗅觉减退/丧失和味觉减退/丧失。在最后一次随访时（中位时间55天，范围28-105天），RT-PCR阳性组中44.7%的患者仍报告有症状，而阴性组为18.3%（<0.001），主要症状为嗅觉减退/丧失（16.3%）、呼吸困难（12.2%）和疲劳（10.6%）。个体症状对诊断COVID-19的鉴别价值有限。几乎一半的SARS-CoV-2阳性患者在首次会诊后至少28天仍报告有症状。
