Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Eur J Gen Pract. 2023 Dec;29(1):2270707. doi: 10.1080/13814788.2023.2270707. Epub 2023 Oct 23.
Early in the COVID-19 pandemic, GPs had to distinguish SARS-CoV-2 from other aetiologies in patients presenting with respiratory tract infection (RTI) symptoms on clinical grounds and adapt management accordingly.
To test the diagnostic accuracy of GPs' clinical diagnosis of a SARS-CoV-2 infection in a period when COVID-19 was a new disease. To describe GPs' management of patients presenting with RTI for whom no confirmed diagnosis was available. To investigate associations between patient and clinical features with a SARS-CoV-2 infection.
In April 2020-March 2021, 876 patients (9 countries) were recruited when they contacted their GP with symptoms of an RTI of unknown aetiology. A swab was taken at baseline for later analysis. Aetiology (PCR), diagnostic accuracy of GPs' clinical SARS-CoV-2 diagnosis, and patient management were explored. Factors related to SARS-CoV-2 infection were determined by logistic regression modelling.
GPs suspected SARS-CoV-2 in 53% of patients whereas 27% of patients tested positive for SARS-CoV-2. True-positive patients (23%) were more intensively managed for follow-up, antiviral prescribing and advice than true-negatives (42%). False negatives (5%) were under-advised, particularly for social distancing and isolation. Older age (OR: 1.02 (1.01-1.03)), male sex (OR: 1.68 (1.16-2.41)), loss of taste/smell (OR: 5.8 (3.7-9)), fever (OR: 1.9 (1.3-2.8)), muscle aches (OR: 2.1 (1.5-3)), and a known risk factor for COVID-19 (travel, health care worker, contact with proven case; OR: 2.7 (1.8-4)) were predictive of SARS-CoV-2 infection. Absence of loss of taste/smell, fever, muscle aches and a known risk factor for COVID-19 correctly excluded SARS-CoV-2 in 92.3% of patients, whereas presence of 3, or 4 of these variables correctly classified SARS-CoV-2 in 57.7% and 87.1%.
Correct clinical diagnosis of SARS-CoV-2 infection, without POC-testing available, appeared to be complicated.
在 COVID-19 大流行初期，全科医生必须根据临床症状从呼吸道感染 (RTI) 症状的患者中区分 SARS-CoV-2 和其他病因，并相应调整治疗方案。
检验全科医生在 COVID-19 为新疾病时期对 SARS-CoV-2 感染的临床诊断的准确性。描述全科医生对无明确诊断的 RTI 患者的治疗管理。调查患者和临床特征与 SARS-CoV-2 感染之间的关联。
2020 年 4 月至 2021 年 3 月，当 876 名（来自 9 个国家）患者因未知病因的 RTI 症状联系其全科医生时，招募了他们。在基线时采集了拭子，以便以后进行分析。探索了病因（PCR）、全科医生临床 SARS-CoV-2 诊断的准确性以及患者管理。通过逻辑回归模型确定与 SARS-CoV-2 感染相关的因素。
全科医生怀疑 53%的患者患有 SARS-CoV-2，而 27%的患者 SARS-CoV-2 检测呈阳性。真正的阳性患者（23%）比真正的阴性患者（42%）更需要接受随访、抗病毒药物治疗和建议。假阴性患者（5%）的建议不足，尤其是在保持社交距离和隔离方面。年龄较大（OR：1.02（1.01-1.03））、男性（OR：1.68（1.16-2.41））、味觉/嗅觉丧失（OR：5.8（3.7-9））、发热（OR：1.9（1.3-2.8））、肌肉疼痛（OR：2.1（1.5-3））和 COVID-19 的已知危险因素（旅行、医护人员、与确诊病例接触；OR：2.7（1.8-4））是 SARS-CoV-2 感染的预测因素。没有味觉/嗅觉丧失、发热、肌肉疼痛和 COVID-19 的已知危险因素的患者可正确排除 92.3%的 SARS-CoV-2 感染，而存在 3 种或 4 种这些变量时可正确分类 SARS-CoV-2 感染，敏感性为 57.7%，特异性为 87.1%。
在没有 POCT 检测的情况下，正确诊断 SARS-CoV-2 感染似乎很复杂。
