Assessment of the Utility of a Screening Tool for COVID-19 Diagnosis in an Accident and Emergency Department in Lagos, Nigeria: A Pilot Study

Nigerian Postgraduate Medical Journal

article

Erereoghor Otrofanowei¹  Iorhen Ephraim Akase¹  Bolaji Oluwarotimi Olopade²  Patricia E. Akintan³  Uyiekpen E. Ima-Edomwonyi²  Yeside Olubunmi Akinbolagbe³  Osigwe Paul Agabi¹  Danladi Abraham Nmadu²  Gbemileke O. Akinbode⁴  Adefolarin Opawoye²  C. Aramide Olasope²  Adewale Ogundare²  B. Abiola Bolarinwa⁵  Oluwakemi Elizabeth Awojumobi-Otokiti⁵  Precious J. Enajeroh²  Moses Karami²  Christopher Imokhuede Esezobor³  Gbenga Olorunfemi⁶  Yewande O. Oshodi⁷  Ayotunde Ayodeji Oluwole⁸  Wasiu Lanre Adeyemo⁹  Christopher O. Bode¹ 

[1] Department of Medicine, University of Lagos;Department of Medicine, Lagos University Teaching Hospital;Department of Pediatrics, College of Medicine, University of Lagos;Department of Surgery, Lagos University Teaching Hospital;Department of Hematology and Blood Transfusion, Lagos University Teaching Hospital;Division of Epidemiology and Biostatistics, University of Witwatersrand;Department of Psychiatry, University of Lagos;Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos;Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos

关键词: Accident and emergency;    COVID-19;    reverse transcription–polymerase chain reaction;    screening tool;   

DOI  :  10.4103/npmj.npmj_779_21

学科分类：地球科学(综合)

来源: Medknow

【 摘 要 】

The use of reverse transcription–polymerase chain reaction (RT-PCR) is the gold standard laboratory test for diagnosing SARS-CoV-2 infection. However, it has the disadvantage of a long turnaround time and cost. The Nigeria Centre for Disease Control (NCDC) formulated a case definition for COVID-19. We sought to determine the utility of a 14-item, point-weighted clinical screening questionnaire adapted from the NCDC case definition in identifying patients more likely to have the disease. This was to aid prompt clinical decision-making. Methods: We retrospectively reviewed the data of 113 non-surgical patients presenting to the Accident and Emergency Department (A and E) of Lagos University Teaching Hospital, Lagos, Nigeria. Patients were stratified based on screening scores into low (0–2), moderate (3–5) and high (6) pre-test categories. Patients with low and high scores ≥6 were admitted to the A and E and the COVID-19 holding ward, respectively, while the moderate group had chest computed tomography scans to aid further decision-making, pending the outcome of their RT-PCR results. The validity of the triage score as compared to the RT-PCR test result was calculated and the kappa score of agreement was utilised to evaluate the concordance between two triage scores. The optimum cut-off score was also obtained based on the maximal Younden's index. Results: The frequencies of low, moderate and high pre-test scores were 34 (30%), 43 (38.1%) and 36 (31.9%), respectively. Overall, 38.1% (43/113) were RT-PCR positive. RT-PCR was positive in 26.5% (9/34) with low screening scores, 55.8% (24/43) with moderate scores and 27.8% (10/36) with high scores. The sensitivity and specificity of a high score of 6 were 25% and 92.86%, while the lower score of 3 had sensitivity and specificity of 62.5% and 58.6%, respectively. Conclusion: The screening tool showed a high specificity in its initial design, which suggests that anyone with a low score using this tool has a high probability of testing negative. We recommend a cut-off score of 4 (score A) or 6 (score B) of the current screening tool be used to increase the chances of identifying persons with COVID-19 for RT-PCR testing.

【 授权许可】

CC BY-NC-SA