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Symptom Criteria for COVID‐19 Testing of Heath Care Workers
Author(s) -
Clemency Brian M.,
Varughese Renoj,
Scheafer Danielle K.,
Ludwig Brian,
Welch Jacob V.,
McCormack Robert F.,
Ma Changxing,
Nan Nan,
Giambra Theresa,
Raab Thomas
Publication year - 2020
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.14009
Subject(s) - medicine , confidence interval , observational study , covid-19 , pre and post test probability , emergency medicine , test (biology) , disease , infectious disease (medical specialty) , paleontology , biology
Background 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. Methods 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. Results 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). Conclusion 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.