Clinical diagnosis of SARS-CoV-2 infection: An observational study of respiratory tract infection in primary care in the early phase of the pandemic.

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

European Journal of General Practice Pub Date : 2023-12-01 Epub Date: 2023-10-23 DOI:10.1080/13814788.2023.2270707

Alike W van der Velden, Milensu Shanyinde, Emily Bongard, Femke Böhmer, Slawomir Chlabicz, Annelies Colliers, Ana García-Sangenís, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Ly-Mee Yu, Katherine Loens, Margareta Ieven, Theo J Verheij, Herman Goossens, Akke Vellinga, Christopher C Butler

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引用次数: 0

Abstract

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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%.

Conclusion: Correct clinical diagnosis of SARS-CoV-2 infection, without POC-testing available, appeared to be complicated.

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严重急性呼吸系统综合征冠状病毒2型感染的临床诊断：大流行早期初级保健中呼吸道感染的观察性研究。

背景：在新冠肺炎大流行早期，全科医生必须在临床上将出现呼吸道感染（RTI）症状的患者的SARS-CoV-2与其他病因区分开来，并相应地调整管理。目的：在新冠肺炎是一种新疾病的时期，测试全科医生对SARS-CoV-2感染的临床诊断的准确性。描述全科医生对没有确诊诊断的RTI患者的管理。研究严重急性呼吸系统综合征冠状病毒2型感染患者和临床特征之间的关系。方法：2020年4月至2021年3月，876名患者（9个国家）因病因不明的RTI症状联系了他们的全科医生。在基线处取拭子进行后续分析。探讨了病因（PCR）、全科医生临床诊断严重急性呼吸系统综合征冠状病毒2型的诊断准确性和患者管理。通过逻辑回归模型确定与严重急性呼吸系统综合征冠状病毒2型感染相关的因素。结果：53%的患者被全科医生怀疑为严重急性呼吸系统综合征冠状病毒2型，而27%的患者检测为严重急性急性呼吸系统综合症冠状病毒2型阳性。与真阴性患者（42%）相比，真阳性患者（23%）在随访、抗病毒处方和建议方面得到了更严格的管理。假阴性（5%）建议不足，尤其是在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））、发烧（OR:1.9（1.3-2.8））、肌肉疼痛（OR:2.1（1.5-3））和已知的新冠肺炎危险因素（旅行、医护人员、与确诊病例接触；OR:2.7（1.8-4））可预测SARS-CoV-2感染。在92.3%的患者中，没有味觉/嗅觉丧失、发烧、肌肉疼痛和已知的新冠肺炎危险因素，正确地排除了SARS-CoV-2，而其中3或4个变量的存在正确地将SARS-CoV-2分类为57.7%和87.1%。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of General Practice PRIMARY HEALTH CARE-MEDICINE, GENERAL & INTERNAL

CiteScore

5.10

自引率

5.90%

发文量

审稿时长

>12 weeks

期刊介绍： The EJGP aims to: foster scientific research in primary care medicine (family medicine, general practice) in Europe stimulate education and debate, relevant for the development of primary care medicine in Europe. Scope The EJGP publishes original research papers, review articles and clinical case reports on all aspects of primary care medicine (family medicine, general practice), providing new knowledge on medical decision-making, healthcare delivery, medical education, and research methodology. Areas covered include primary care epidemiology, prevention, diagnosis, pharmacotherapy, non-drug interventions, multi- and comorbidity, palliative care, shared decision making, inter-professional collaboration, quality and safety, training and teaching, and quantitative and qualitative research methods.