Diagnostic Performance of Individual Symptoms to Predict SARS-CoV-2 RT-PCR Positivity and Symptom Persistence among Suspects Presenting in Primary Care during the First Wave of COVID-19
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Setting
2.3. Participants
2.4. Data Source
2.5. Sample Size
2.6. RT-PCR
2.7. Statistical Analysis
3. Results
3.1. Sociodemographic Characteristics of the Study Participants
3.2. Symptoms and Signs
3.3. Symptom Duration
3.4. Factors Associated with Symptom Duration
4. Discussion
4.1. Main Findings
4.2. Comparison with Existing Literature
4.3. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total (N = 883) | RT-PCR Positive (N = 123) | RT-PCR Negative (N = 606) | Not Tested (N = 154) | |
---|---|---|---|---|
Median age in years (IQR) | 38 (29–50) | 43 (31–56) | 38 (29–50) | 37 (29–45) |
Female, n (%) | 522 (59.1) | 80 (65.0) | 367 (60.6) | 75 (48.7) |
Study sites, n (%) | ||||
Walk-in clinic «A» | 664 (75.2) | 96 (78.1) | 416 (68.7) | 152 (98.7) |
Walk-in clinic «B» | 170 (19.3) | 18 (14.6) | 150 (24.8) | 2 (1.3) |
Private practice | 49 (5.6) | 9 (7.3) | 40 (6.6) | 0 (0.0) |
Professionally active in health care, n (%) | 278 (41.4) | 56 (45.5) | 198 (32.7) | 24 (15.6) |
Education level, n (%; 34 missing) | ||||
Low | 368 (43.4) | 67 (54.9) | 232 (40.5) | 69 (44.8) |
Medium | 242 (28.5) | 35 (28.7) | 170 (29.7) | 37 (24.0) |
High | 239 (28.2) | 20 (16.4) | 171 (29.8) | 48 (31.2) |
Occupation level, n (%; 63 missing) | ||||
Low | 136 (16.6) | 34 (28.6) | 80 (14.5) | 22 (14.8) |
Medium | 617 (75.2) | 75 (63.9) | 421 (76.3) | 121 (81.2) |
High | 67 (8.2) | 10 (8.4) | 51 (9.2) | 6 (4.0) |
≥1 risk factor *, n (%) | 190 (21.5) | 28 (22.8) | 135 (22.3) | 27 (17.5) |
Current tobacco use, n (%) | 208 (25.1) | 17 (14.1) | 159 (26.7) | 41 (28.1) |
NSAID use 7 days prior the first visit, n (%) | 119 (13.5) | 15 (12.2) | 78 (12.9) | 26 (16.9) |
Hospitalized after the initial consultation, n (%) | 33 (3.7) | 11 (8.9) | 17 (2.8) | 5 (3.3) |
Symptoms and Signs | Sensitivity | Specificity | PPV 2 | NPV 3 | c-Index | |||||
---|---|---|---|---|---|---|---|---|---|---|
% | 95%CI | % | 95%CI | % | 95%CI | % | 95%CI | % | 95%CI | |
Cough | 80.5 | (72.4–87.1) | 34.1 | (30.3–38.0) | 19.9 | (16.5–23.7) | 89.6 | (84.9–93.2) | 0.57 | (0.53–0.61) |
History of fever | 65.6 | (56.4–73.9) | 52.6 | (47.5–55.6) | 21.5 | (17.4–26.0) | 88.1 | (84.3–91.3) | 0.59 | (0.54–0.63) |
Sore throat | 51.8 | (42.1–61.4) | 44.7 | (40.6–48.8) | 15 | (11.6–19.0) | 83.1 | (78.4–87.1) | 0.48 | (0.43–0.53) |
Myalgia | 68.8 | (59.3–77.2) | 49.5 | (45.2–53.7) | 21.4 | (17.3–26.1) | 88.7 | (84.7–92.0) | 0.59 | (0.54–0.64) |
Dyspnea | 40.2 | (31.4–49.4) | 60.8 | (56.8–64.7) | 17.2 | (13.0–22.1) | 83.4 | (79.6–86.7) | 0.51 | (0.46–0.55) |
Headache | 49.5 | (39.6–59.5) | 57.1 | (52.3–61.8) | 21.9 | (16.8–27.8) | 82.3 | (77.5–86.4) | 0.53 | (0.48–0.59) |
Fatigue | 40.6 | (30.9–50.8) | 62 | (57.1–66.8) | 21.1 | (15.6–27.6) | 80.6 | (75.8–84.9) | 0.51 | (0.46–0.57) |
History of temperature ≥38 °C | 33.9 | (25.5–43.0) | 81.5 | (78.1–84.5) | 26.8 | (20.0–34.5) | 86 | (82.9–88.8) | 0.58 | (0.53–0.62) |
Rhinorrhea | 32 | (23.2–42.0) | 69.1 | (64.5–73.4) | 19.8 | (14.0–26.6) | 81.1 | (76.7–84.9) | 0.51 | (0.46–0.56) |
Chest pain | 20 | (12.7–29.2) | 70.7 | (66.0–75.1) | 14.4 | (9.0–21.3) | 78.2 | (73.6–82.3) | 0.45 | (0.41–0.50) |
Hypo-/ageusia | 51.2 | (40.1–62.1) | 86.1 | (82.8–89.0) | 38.3 | (29.4–47.8) | 91.3 | (88.4–93.6) | 0.69 | (0.63–0.74) |
Hypo-/anosmia | 47.1 | (36.3–58.1) | 88.3 | (85.1–90.9) | 40.6 | (30.9–50.8) | 90.7 | (87.8–93.1) | 0.68 | (0.62–0.73) |
Digestive symptoms 1 | 21.9 | (14.4–31.0) | 77.6 | (73.4–81.5) | 19.5 | (12.8–27.8) | 80.1 | (75.9–83.8) | 0.5 | (0.45–0.54) |
Chills | 10.5 | (5.2–18.5) | 86.6 | (82.9–89.8) | 15.9 | (7.9–27.3) | 80.1 | (76.0–83.8) | 0.49 | (0.45–0.52) |
Abdominal pain | 8.2 | (3.6–15.5) | 86.5 | (82.7–89.7) | 13.3 | (5.9–24.6) | 78.7 | (74.5–82.5) | 0.47 | (0.44–0.51) |
Dyspnea >4 days | 19.6 | (10.2–32.4) | 83.4 | (80.3–86.1) | 9 | (4.6–15.6) | 92.5 | (90.1–94.5) | 0.52 | (0.46–0.57) |
Fever >4 days | 8.3 | (4.0–14.7) | 97.2 | (95.5–98.3) | 37 | (19.4–57.6) | 84.1 | (81.1–86.7) | 0.53 | (0.50–0.55) |
Sweating | 9.5 | (4.4–17.2) | 94.6 | (91.7–96.6) | 31 | (15.3 -50.8) | 80.2 | (76.1–83.8) | 0.52 | (0.49–0.55) |
Variable | ≥1 Symptom | Cough | History of Fever | Sore Throat | Dyspnea | Anosmia |
---|---|---|---|---|---|---|
Walk-in clinic «B» (vs. clinic «A») | 1.05 (p = 0.627) | 1.03 (p = 0.818) | 1.09 (p = 0.504) | 1.14 (p = 0.315) | 0.71 (p = 0.013) | 0.68 (p = 0.111) |
Private practice (vs. clinic «A») | 0.69 (p = 0.031) | 0.83 (p = 0.314) | 0.84 (p = 0.471) | 0.79 (p = 0.301) | 0.67 (p = 0.182) | 0.65 (p = 0.341) |
Positive RT-PCR test | 0.48 (p < 0.001) | 0.94 (p = 0.581) | 0.90 (p = 0.447) | 0.97 (p = 0.833) | 0.69 (p = 0.020) | 0.62 (p = 0.015) |
≥1 risk factor * | 1.03 (p = 0.810) | 0.90 (p = 0.333) | 0.96 (p = 0.782) | 1.12 (p = 0.359) | 0.86 (p = 0.260) | 0.83 (p = 0.378) |
Age ≤ 40 years | 1.38 (p < 0.001) | 1.21 (p = 0.059) | 1.10 (p = 0.403) | 1.21 (p = 0.085) | 1.10 (p = 0.438) | 1.39 (p = 0.064) |
Age > 65 years | 1.27 (p = 0.161) | 0.96 (p = 0.830) | 1.10 (p = 0.694) | 1.03 (p = 0.886) | 0.69 (p = 0.144) | 1.83 (p = 0.162) |
BMI ≤ 20 kg/m2 | 0.96 (p = 0.752) | 0.94 (p = 0.678) | 0.89 (p = 0.483) | 0.95 (p = 0.772) | 1.19 (p = 0.351) | 0.84 (p = 0.545) |
BMI > 25 kg/m2 | 0.91 (p = 0.312) | 1.06 (p = 0.581) | 0.94 (p = 0.606) | 0.88 (p = 0.268) | 1.07 (p = 0.584) | 1.27 (p = 0.201) |
Female | 0.82 (p = 0.020) | 0.87 (p = 0.149) | 0.92 (p = 0.477) | 0.92 (p = 0.462) | 0.81 (p = 0.111) | 0.89 (p = 0.533) |
Professionally active in health care | 1.20 (p = 0.050) | 1.28 (p = 0.018) | 1.21 (p = 0.121) | 1.25 (p = 0.052) | 1.09 (p = 0.550) | 0.83 (p = 0.335) |
Current tobacco use | 0.96 (p = 0.658) | 0.85 (p = 0.147) | 1.06 (p = 0.642) | 0.82 (p = 0.130) | 0.90 (p = 0.487) | 0.96 (p = 0.844) |
NSAID use 7 days prior the first visit | 0.80 (p = 0.054) | 0.90 (p = 0.423) | 0.86 (p = 0.333) | 0.69 (p = 0.009) | 1.16 (p = 0.337) | 0.83 (p = 0.495) |
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Savoy, M.; Kopp, B.; Chaouch, A.; Cohidon, C.; Gouveia, A.; Lombardo, P.; Maeder, M.; Payot, S.; Perdrix, J.; Schwarz, J.; et al. Diagnostic Performance of Individual Symptoms to Predict SARS-CoV-2 RT-PCR Positivity and Symptom Persistence among Suspects Presenting in Primary Care during the First Wave of COVID-19. Infect. Dis. Rep. 2023, 15, 112-124. https://doi.org/10.3390/idr15010012
Savoy M, Kopp B, Chaouch A, Cohidon C, Gouveia A, Lombardo P, Maeder M, Payot S, Perdrix J, Schwarz J, et al. Diagnostic Performance of Individual Symptoms to Predict SARS-CoV-2 RT-PCR Positivity and Symptom Persistence among Suspects Presenting in Primary Care during the First Wave of COVID-19. Infectious Disease Reports. 2023; 15(1):112-124. https://doi.org/10.3390/idr15010012
Chicago/Turabian StyleSavoy, Mona, Benoît Kopp, Aziz Chaouch, Christine Cohidon, Alexandre Gouveia, Patrick Lombardo, Muriel Maeder, Sylvie Payot, Jean Perdrix, Joëlle Schwarz, and et al. 2023. "Diagnostic Performance of Individual Symptoms to Predict SARS-CoV-2 RT-PCR Positivity and Symptom Persistence among Suspects Presenting in Primary Care during the First Wave of COVID-19" Infectious Disease Reports 15, no. 1: 112-124. https://doi.org/10.3390/idr15010012