Guidelines for Triage of COVID-19 Patients Presenting With Multisystemic Symptoms

Area of Science:

• Infectious Diseases
• Public Health
• Diagnostic Accuracy

Background:

• Differentiating coronavirus disease-2019 (COVID-19) from other illnesses is crucial for effective patient triage in community settings.
• Multisystemic symptoms, encompassing both respiratory and nonrespiratory manifestations, offer potential for improved diagnostic differentiation.

Purpose of the Study:

• To evaluate the utility of various COVID-19 symptoms and their combinations in predicting diagnosis.
• To assess the accuracy of symptom-based diagnosis for COVID-19 in a community setting.

Main Methods:

• A scoping literature review identified COVID-19 symptoms, followed by a survey of 483 individuals with reported symptoms and RT-PCR results.
• Likelihood ratios were calculated from literature data, and diagnostic accuracy was assessed using the area under the receiver operating curve (AROC).

Main Results:

• Individual symptoms like cough or fever were poor predictors of COVID-19.
• Diagnostic accuracy was significantly higher when symptoms involved multiple body systems (AROC 0.74-0.81) compared to respiratory symptoms alone (AROC 0.48).

Conclusions:

• No single symptom reliably diagnoses COVID-19 in the community.
• Combining symptoms across different body systems enhances diagnostic accuracy, aiding in patient triage when testing is limited.