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From Brief19: How reliable are clinical findings in diagnosing Covid-19?

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May 22, 2020

In a prospective observational study published in The Annals of Emergency Medicine, 391 adult patients suspected to have covid-19 were tested for SARS-CoV-2 at an emergency department in France. The subjects were assessed in order to determine whether certain clinical findings are indicative of covid-19. Clinicians documented symptoms and rated each patient as either low, moderate, or high suspicion for covid-19. Of the 273 patients studied, 57.6 percent were found to be positive for SARS-CoV-2. Of those, nearly 24 percent experienced gastrointestinal symptoms.

However, the most powerful indicator of active disease was loss of smell, known as anosmia. The "likelihood ratio" for anosmia and covid-19 was 7.6, which is considered substantial by clinicians (i.e. the presence of this finding truly makes the diagnosis of covid-19 much more likely). On the other hand, the lack of anosmia does not appear to mean that the virus can be ruled out. In addition, ultrasound showing fluid in both lungs was another feature seen to increase the likelihood of covid-19 being present. However, because the fraction of patients in the study was so high, these findings might not be as useful to clinicians trying to use this knowledge to assess patient populations in which the disease is less common.

Shared with permission from Brief19, a daily review of #covid-19 research and policy.

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