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Diagnostic accuracy of physician's gestalt in suspected COVID-19: Prospective bicentric study

Peiman Nazerian1, Fulvio Morello2,3, Alessio Prota1

  • 1Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|February 12, 2021
PubMed

Insights

Physician gestalt, incorporating clinical findings and bedside imaging, shows fair accuracy in diagnosing COVID-19. Combining clinical and imaging gestalt with RT-PCR testing improves diagnostic sensitivity for COVID-19.

Area of Science:

  • Emergency Medicine
  • Infectious Diseases
  • Diagnostic Accuracy

Background:

  • Physician gestalt is crucial for diagnosing COVID-19 due to the lack of a single definitive test.
  • Accurate diagnosis in the emergency department (ED) is vital for timely patient management.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of physician gestalt for COVID-19 in the ED.
  • To compare gestalt based on clinical findings alone versus clinical findings integrated with bedside imaging.

Main Methods:

  • Prospective enrollment of patients with suspected COVID-19 in two EDs.
  • Physicians assessed likelihood of COVID-19 using clinical gestalt (CG) and clinical and bedside imaging-integrated gestalt (CBIIG).
  • Final diagnosis adjudicated by 30-day follow-up data.

Main Results:

  • Clinical gestalt (CG) and CBIIG demonstrated fair diagnostic accuracy (AUC 80.8% and 91.6%).
  • CBIIG showed similar accuracy to RT-PCR for SARS-CoV-2 on initial testing.
  • CBIIG combined with RT-PCR achieved higher sensitivity (98.4%) compared to CG plus RT-PCR (95.9%).

Conclusions:

  • Physician gestalt, particularly CBIIG, offers valuable diagnostic information for suspected COVID-19.
  • Negative RT-PCR results combined with low CBIIG probability can effectively rule out COVID-19.
  • Integrating bedside imaging into physician gestalt enhances diagnostic performance in the ED.
Abstract

Keywords:
COVID-19diagnosisemergency departmentgestaltlung ultrasound chest x-ray

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