Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease

Some people with SARS-CoV-2 infection remain asymptomatic, whilst in others the infection can cause mild to moderate COVID-19 disease and COVID-19 pneumonia, leading some patients to require intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever or co...

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Bibliographic Details
Published in:	Cochrane database of systematic reviews 2020-07, Vol.7 (7), p.CD013665-CD013665
Main Authors:	Struyf, Thomas, Deeks, Jonathan J, Dinnes, Jacqueline, Takwoingi, Yemisi, Davenport, Clare, Leeflang, Mariska Mg, Spijker, René, Hooft, Lotty, Emperador, Devy, Dittrich, Sabine, Domen, Julie, Horn, Sebastiaan R A, Van den Bruel, Ann
Format:	Article
Language:	eng
Subjects:	Ambulatory Care Arthralgia - diagnosis Arthralgia - etiology Betacoronavirus Coronavirus Infections - complications Coronavirus Infections - diagnosis Coronavirus Infections - epidemiology COVID-19 Diagnosis Fatigue - diagnosis Fatigue - etiology Fever - diagnosis Fever - etiology Headache - diagnosis Humans Infectious disease Myalgia - diagnosis Myalgia - etiology Outpatient Clinics, Hospital - statistics & numerical data Pandemics Physical Examination Pneumonia, Viral - complications Pneumonia, Viral - diagnosis Pneumonia, Viral - epidemiology Primary Health Care SARS-CoV-2 Selection Bias Symptom Assessment - classification Symptom Assessment - statistics & numerical data
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Summary:	Some people with SARS-CoV-2 infection remain asymptomatic, whilst in others the infection can cause mild to moderate COVID-19 disease and COVID-19 pneumonia, leading some patients to require intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever or cough, and signs such as oxygen saturation or lung auscultation findings, are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19 disease, or select patients for further diagnostic testing. To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19 disease or COVID-19 pneumonia. On 27 April 2020, we undertook electronic searches in the Cochrane COVID-19 Study Register and the University of Bern living search database, which is updated daily with published articles from PubMed and Embase and with preprints from medRxiv and bioRxiv. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. Studies were eligible if they included patients with suspected COVID-19 disease, or if they recruited known cases with COVID-19 disease and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards including reverse transcription polymerase chain reaction (RT-PCR), clinical expertise, imaging, serology tests and World Health Organization (WHO) or other definitions of COVID-19. Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the QUADAS-2 checklist. Analyses were descriptive, presenting sensitivity and specificity in paired forest plots, in ROC (receiver operating characteristic) space and in dumb
ISSN:	1469-493X