Accuracy of Emergency Department clinical findings for diagnostic of coronavirus disease-2019

Peyrony, Olivier; Marbeuf-Gueye, Carole; Truong, Vy; Giroud, Marion; Rivière, Clémentine; Khenissi, Khalil; Legay, Léa; Simonetta, Marie; Elezi, Arben; Principe, Alessandra; Taboulet, Pierre; Ogereau, Carl; Tourdjman, Mathieu; Ellouze, Sami; Fontaine, Jean-Paul

Abstract: Objective We sought to describe the medical history and clinical findings of patients attending the ED with suspected COVID-19 and estimate the diagnostic accuracy of patients’ characteristics for predicting COVID-19. Methods We prospectively enrolled all patients tested for SARS-CoV-2 by RT-PCR in our ED from March 9, 2020 to April 4, 2020. We abstracted medical history, physical examination findings, and the clinical probability of COVID-19 (“low”, “moderate”, “high”) rated by emergency physicians depending on their clinical judgment. We assessed diagnostic accuracy of these characteristics for COVID-19 by calculating positive and negative likelihood ratios (LR+/LR-). Results We included 391 patients of whom 225 tested positive for SARS-CoV-2. RT-PCR was more likely to be negative when the emergency physician thought that clinical probability was low, and more likely to be positive when she or he thought that clinical probability was high. Patient-reported anosmia and the presence of bilateral B-lines on lung ultrasound had the highest LR+ for the diagnosis of COVID-19 (7.58; 95% CI 2.36–24.36 and 7.09; 95% CI 2.77–18.12 respectively). The absence of a high clinical probability determined by the emergency physician and the absence of bilateral B-lines on lung ultrasound had the lowest LR- for the diagnosis of COVID-19 (0.33; 95% CI 0.25–0.43 and 0.26; 95% CI 0.15–0.45 respectively). Conclusions Anosmia, emergency physician estimate of high clinical probability and bilateral B-lines on lung ultrasound increased the likelihood of identifying COVID-19 in patients presenting to the ED.