Rapid identification of SARS-CoV-2-infected patients at the emergency department using routine testing

• Published in: Clinical chemistry and laboratory medicine Vol. 58; no. 9; pp. 1587 - 1593
• Main Authors: Kurstjens, Steef, van der Horst, Armando, Herpers, Robert, Geerits, Mick W. L., Kluiters-de Hingh, Yvette C. M., Göttgens, Eva-Leonne, Blaauw, Martinus J. T., Thelen, Marc H. M., Elisen, Marc G. L. M., Kusters, Ron
• Format: Journal Article
• Language: English
• Published: Germany De Gruyter 27.08.2020; Walter De Gruyter & Company
• Subjects: Aged; algorithm; Algorithms; Betacoronavirus; C-reactive protein; C-Reactive Protein - analysis; Clinical Laboratory Techniques; Computed tomography; Computer applications; coronavirus; Coronavirus Infections - blood; Coronavirus Infections - diagnosis; Coronaviruses; COVID-19; COVID-19 Testing; Diagnostic Tests, Routine - methods; emergency department; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Ferritin; Ferritins - blood; Health risks; Humans; Infections; L-Lactate dehydrogenase; L-Lactate Dehydrogenase - blood; Lactate dehydrogenase; Lactic acid; Lymphocyte Count; Lymphocytes; Male; Mathematical models; Medical personnel; Middle Aged; Neutrophils - metabolism; Overcrowding; pandemic; Pandemics; Parameters; Patients; Pneumonia, Viral - blood; Pneumonia, Viral - diagnosis; Polymerase chain reaction; prediction-model; Retrospective Studies; Reverse Transcriptase Polymerase Chain Reaction; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Viral diseases; COVID-19; prediction-model; SARS-CoV-2; coronavirus; emergency department; pandemic; algorithm
• ISSN: 1434-6621; 1437-4331
• DOI: 10.1515/cclm-2020-0593

The novel coronavirus disease 19 (COVID-19), caused by SARS-CoV-2, spreads rapidly across the world. The exponential increase in the number of cases has resulted in overcrowding of emergency departments (ED). Detection of SARS-CoV-2 is based on an RT-PCR of nasopharyngeal swab material. However, RT-PCR testing is time-consuming and many hospitals deal with a shortage of testing materials. Therefore, we aimed to develop an algorithm to rapidly evaluate an individual's risk of SARS-CoV-2 infection at the ED. In this multicenter retrospective study, routine laboratory parameters (C-reactive protein, lactate dehydrogenase, ferritin, absolute neutrophil and lymphocyte counts), demographic data and the chest X-ray/CT result from 967 patients entering the ED with respiratory symptoms were collected. Using these parameters, an easy-to-use point-based algorithm, called the corona-score, was developed to discriminate between patients that tested positive for SARS-CoV-2 by RT-PCR and those testing negative. Computational sampling was used to optimize the corona-score. Validation of the model was performed using data from 592 patients. The corona-score model yielded an area under the receiver operating characteristic curve of 0.91 in the validation population. Patients testing negative for SARS-CoV-2 showed a median corona-score of 3 vs. 11 (scale 0-14) in patients testing positive for SARS-CoV-2 (p<0.001). Using cut-off values of 4 and 11 the model has a sensitivity and specificity of 96 and 95%, respectively. The corona-score effectively predicts SARS-CoV-2 RT-PCR outcome based on routine parameters. This algorithm provides the means for medical professionals to rapidly evaluate SARS-CoV-2 infection status of patients presenting at the ED with respiratory symptoms.