Diagnostic yield of screening for SARS-CoV-2 among patients admitted to hospital for alternate diagnoses: an observational cohort study
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Abstract
To determine the diagnostic yield of screening patients for SARS-CoV-2 who were admitted with a diagnosis unrelated to COVID-19 and to identify risk factors for positive tests.
Design
Cohort from the Canadian COVID-19 Emergency Department Rapid Response Network registry.
Setting
30 acute care hospitals across Canada.
Participants
Patients hospitalised for non-COVID-19-related diagnoses who were tested for SARS-CoV-2 between 1 March and 29 December 2020.
Main outcome
Positive nucleic acid amplification test for SARS-CoV-2.
Outcome measure
Diagnostic yield.
Results
We enrolled 15 690 consecutive eligible adults who were admitted to hospital without clinically suspected COVID-19. Among these patients, 122 tested positive for COVID-19, resulting in a diagnostic yield of 0.8% (95% CI 0.64% to 0.92%). Factors associated with a positive test included presence of fever, being a healthcare worker, having a positive household contact or institutional exposure, and living in an area with higher 7-day average incident COVID-19 cases.
Conclusions
Universal screening of hospitalised patients for COVID-19 across two pandemic waves had a low diagnostic yield and should be informed by individual-level risk assessment in addition to regional COVID-19 prevalence.
Trial registration number
NCT04702945 .
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SciScore for 10.1101/2021.09.23.21264036: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Field Sample Permit: The research ethics boards of all participating institutions approved this study with a waiver of informed consent for data collection and linkage.
IRB: The research ethics boards of all participating institutions approved this study with a waiver of informed consent for data collection and linkage.
Consent: The research ethics boards of all participating institutions approved this study with a waiver of informed consent for data collection and linkage.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data Collection: Trained research assistants … SciScore for 10.1101/2021.09.23.21264036: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Field Sample Permit: The research ethics boards of all participating institutions approved this study with a waiver of informed consent for data collection and linkage.
IRB: The research ethics boards of all participating institutions approved this study with a waiver of informed consent for data collection and linkage.
Consent: The research ethics boards of all participating institutions approved this study with a waiver of informed consent for data collection and linkage.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data Collection: Trained research assistants collected data retrospectively from electronic and/or paper-based medical records into a central, web-based REDCap database (Vanderbilt University; Nashville, TN, USA). REDCapsuggested: (REDCap, RRID:SCR_003445)Statistical analysis was preformed using Stata (Version 16.1, StataCorp, College Station, Texas). StataCorpsuggested: (Stata, RRID:SCR_012763)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:A limitation of our study is that we only considered NAATs and did not consider the diagnostic yield of antigen-based COVID-19 tests, as they were not widespread in Canada in 2020 (16). We were unable to examine the sensitivity and specificity of the SARS-CoV-2 NAATs as we were unable to define false positive tests, so it is possible that some of the positive test results we encountered are false positives, leading to an overestimation of diagnostic yield. While our study is based on a Canadian population without international sites, we believe our findings are generalizable given their wide geographic spread, and the cultural and racial diversity of our patient population. Finally, as data becomes available on the fourth wave of the pandemic, a future study should examine the impact of widespread vaccination on the yield of screening. As a larger proportion of the population is protected from severe disease and death through vaccination, decision makers should carefully consider the low diagnostic yield of a universal testing strategy going forward.
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04702945 Recruiting Canadian COVID-19 Emergency Department Registry Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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