ArticleAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2021
Diagnostic accuracy of physician's gestalt in suspected COVID-19: Prospective bicentric study.
Article in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19.The Cochrane database of systematic reviews · 2022Pooled it
- Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department.Medicina (Kaunas, Lithuania) · 2023Review
- Ability of emergency medicine clinicians to predict COVID-19 in their patients.The American journal of emergency medicine · 2022Article
- Sort and Sieve: Pre-Triage Screening of Patients with Suspected COVID-19 in the Emergency Department.International journal of environmental research and public health · 2021Observational
- Inter-rater reliability and prospective validation of a clinical prediction rule for SARS-CoV-2 infection.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2021Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesPhysicians' gestalt is central in the diagnostic pipeline of suspected COVID-19, due to the absence of a single tool allowing conclusive rule in or rule out. The aim of this study was to estimate the diagnostic test characteristics of physician's gestalt for COVID-19 in the emergency department (ED), based on clinical findings or on a combination of clinical findings and bedside imaging results.
methodsFrom April 1 to April 30, 2020, patients with suspected COVID-19 were prospectively enrolled in two EDs. Physicians prospectively dichotomized patients in COVID-19 likely or unlikely twice: after medical evaluation of clinical features (clinical gestalt [CG]) and after evaluation of clinical features and results of lung ultrasound or chest x-ray (clinical and bedside imaging-integrated gestalt [CBIIG]). The final diagnosis was adjudicated after independent review of 30-day follow-up data.
resultsAmong 838 ED enrolled patients, 193 (23%) were finally diagnosed with COVID-19. The area under the curve (AUC), sensitivity, and specificity of CG and CBIIG for COVID-19 were 80.8% and 91.6% (p < 0.01), 82.9% and 91.4% (p = 0.01), and 78.6% and 91.8% (p < 0.01), respectively. CBIIG had similar AUC and sensitivity to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 on the first nasopharyngeal swab per se (93.5%, p = 0.24; and 87%, p = 0.17, respectively). CBIIG plus RT-PCR had a sensitivity of 98.4% for COVID-19 (p < 0.01 vs. RT-PCR alone) compared to 95.9% for CG plus RT-PCR (p = 0.05).
conclusionsIn suspected COVID-19, CG and CBIIG have fair diagnostic accuracy, in line with physicians' gestalt for other acute conditions. Negative RT-PCR plus low probability based on CBIIG can rule out COVID-19 with a relatively low number of false-negative cases.
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