Risk factors for a positive SARS-CoV-2 PCR in patients with common cold symptoms in a primary care setting – a retrospective analysis based on a joint documentation standard

  1. Johannes Just
  2. Marie-Therese Puth
  3. Felix Regenold
  4. Klaus Weckbecker
  5. Markus Bleckwenn

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

Combating the COVID-19 pandemic is a major challenge for health systems, citizens and policy makers worldwide. Early detection of affected patients within the large and heterogeneous group of patients with common cold symptoms is an important element of this effort, but often hindered by limited testing resources, false-negative test results and the lack of pathognomonic symptoms in COVID-19. Therefore, we aimed to identify anamnestic items with an increased/decreased odds ratio for a positive SARS-CoV-2 PCR (CovPCR) result in a primary care setting.

Methods

We performed a multi-center cross-sectional cohort study on predictive clinical characteristics for a positive CovPCR over a period of 4 weeks in primary care patients in Germany.

Results

In total, 374 patients in 14 primary care centers received CovPCR and were included in this analysis. The median age was 44.0 (IQR: 31.0–59.0) and a fraction of 10.7% ( n  = 40) tested positive for COVID-19. Patients who reported anosmia had a higher odds ratio (OR: 4.54; 95%-CI: 1.51–13.67) for a positive test result while patients with a sore throat had a lower OR (OR: 0.33; 95%-CI: 0.11–0.97). Furthermore, patients who had a first grade contact with an infected persons and showed symptoms themselves also had an increased OR for positive testing (OR: 5.16; 95% CI: 1.72–15.51). This correlation was also present when they themselves were still asymptomatic (OR: 12.55; 95% CI: 3.97–39.67).

Conclusions

Several anamnestic criteria may be helpful to assess pre-test probability of COVID-19 in patients with common cold symptoms.

Article activity feed

  1. Version published to 10.1186/s12875-020-01322-7
  2. Version published to 10.1101/2020.04.27.20081877v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.04.27.20081877: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study design was reviewed by the ethics committee of the University of Leipzig, Germany under the procedure number 184/20-ek, there were no ethical concerns.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    Strengths and limitations: In this work, predictive factors for a positive CovPCR were investigated for the first time. The evaluation was performed with a multicentric approach and was based on a common documentation standard. The selection of the practices was non-randomized, as a rapid implementation of the study was preferred to a lengthier randomized selection in respect to the pandemics’ rapid evolution. This may have resulted in a distortion of the investigated patient collective, although, no conspicuous deviations were found in comparison to the demographic data of all patients tested in Germany as published by the RKI: the age median in our population was 44 years (IQR: 31-59) compared to 42 years (IQR: 29-56) in a sample of +1.000.000 patients tested in Germany [3]. Therefore, the results could be considered representative for patients in Germany. The major limitation of this study is the small sample size resulting in wide CIs and a connected uncertainty regarding the strength and direction of several effects. Still, this is the first study to show clinical risk factors for a positive CovPCR and its results are in line with the current evidence base [5-8]. Number of patients tested and rates of positives: The proportion of test-positive patients in our population was 10.7%, which is slightly above the average of positive tests performed in Germany during this period (North Rhine-Westphalia (9.3%), Rhineland-Palatinate (9.6%), Hesse (11.8%)) [3]. The number of test...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.04.27.20081877v1 on medRxiv