Open AccessCOVID-MATCH65—A prospectively derived clinical decision rule for severe acute respiratory syndrome coronavirus 2
Author(s) -
Jason A Trubiano,
Sara Vogrin,
Olivia Smibert,
Nada Marhoon,
Adrian A Alexander,
Kyra Chua,
Fiona James,
N. Jones,
Samuel E Grigg,
Cecilia L H Xu,
Nasreen Moini,
Sam R Stanley,
Michael T Birrell,
Morgan Rose,
Claire L. Gordon,
Jason C Kwong,
Natasha E Holmes
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0243414
Subject(s) - medicine , prospective cohort study , logistic regression , predictive value of tests , severe acute respiratory syndrome , severity of illness , clinical prediction rule , covid-19 , positive predicative value , cohort , cohort study , predictive value , disease , infectious disease (medical specialty)
Objectives We report on the key clinical predictors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and present a clinical decision rule that can risk stratify patients for COVID-19. Design, participants and setting A prospective cohort of patients assessed for COVID-19 at a screening clinic in Melbourne, Australia. The primary outcome was a positive COVID-19 test from nasopharyngeal swab. A backwards stepwise logistic regression was used to derive a model of clinical variables predictive of a positive COVID-19 test. Internal validation of the final model was performed using bootstrapped samples and the model scoring derived from the coefficients, with modelling performed for increasing prevalence. Results Of 4226 patients with suspected COVID-19 who were assessed, 2976 patients underwent SARS-CoV-2 testing (n = 108 SARS-CoV-2 positive) and were used to determine factors associated with a positive COVID-19 test. The 7 features associated with a positive COVID-19 test on multivariable analysis were: C OVID-19 patient exposure or international travel, M yalgia/malaise, A nosmia or ageusia, T emperature, C oryza/sore throat, H ypoxia–oxygen saturation < 97%, 65 years or older—summarized in the mnemonic C OVID- MATCH65 . Internal validation showed an AUC of 0.836. A cut-off of ≥ 1.5 points was associated with a 92.6% sensitivity and 99.5% negative predictive value (NPV) for COVID-19. Conclusions From the largest prospective outpatient cohort of suspected COVID-19 we define the clinical factors predictive of a positive SARS-CoV-2 test. The subsequent clinical decision rule, COVID-MATCH65, has a high sensitivity and NPV for SARS-CoV-2 and can be employed in the pandemic, adjusted for disease prevalence, to aid COVID-19 risk-assessment and vital testing resource allocation.