LETTER


Scoring System for the Diagnosis of COVID-19



Mohamed Farouk Allam1, *
1 Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt


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Creative Commons License
© 2020 Mohamed Farouk Allam.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Family Medicine, Faculty of Medicine, Ain Shams University, 11566 Abbasia, Cairo, Egypt; Tel/Fax: +(202) 24346888; E-mail: farouk.allam@med.asu.edu.eg


Abstract

Due to the international spread of COVID-19, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients, a scoring system is needed to classify the suspected patients in order to determine the need for follow-up, home isolation, quarantine or the conduction of further investigations. A scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient.

Keywords: Nasopharyngeal swab, COVID-19, diagnosis, RT-PCR, CT, Score system.



To the Editor:

On the 11th of March 2020, The World Health organization (WHO) declared novel coronavirus (COVID-19) as a pandemic in response to the outbreak in more than 110 countries [1].

The common symptoms and signs of COVID-19 infection include fever, dry cough, shortness of breath, and breathing difficulties. Other less common symptoms include anosmia, sore throat, and runny nose [2, 3].

The Centers for Disease Control and Prevention (CDC) recommended the collection of a nasopharyngeal swab specimen to test for COVID19. Reverse-transcription polymerase chain reaction (RT-PCR) testing is used for detecting COVID-19 RNA [4]. A positive RT-PCR test confirms the diagnosis of COVID-19. If initial testing is negative, but the clinical suspicion remains, the WHO recommends re-sampling and testing from multiple respiratory tract sites [2]. A recent study reported that some patients with positive chest CT findings might present with negative results of RT-PCR for COVID-19 [5].

Due to the international spread of the disease, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients [4, 5], a scoring system is needed to classify the suspected patients in order to determine the need for follow up, home isolation, quarantine or carrying out further investigations.

Table 1. Scoring system for diagnosis of COVID-19.
Epidemiological Evidence of Exposure Yes No
Travel to a Country or an Area with Confirmed Cases of COVID-19 in the last 14 Days.
e.g. USA, UK, China, Italy, South Korea, Iran, Spain.
3 0
OR
Travel or Living in an Area or a District with Confirmed Cases of COVID-19 in the last 14 Days.
e.g. Tourist Resorts in Hurghada or Luxor (Egypt).
3 0
OR
Contact with a Case of COVID-19, either isolated (quarantine or home) or admitted at a Hospital. 3 0
Clinical Symptoms and Signs Yes No
Fever more than 37.4ºC 1 0
Sore Throat AND/OR Runny Nose 1 0
New Dry Cough or Old Dry Cough worsened over the last 3 Days. 1 0
Shortness of Breath or Dyspnea 2 0

If Available:

Investigations Yes No
CBC with Leucopoenia (with or without lymphopenia) 2 0
Chest X Ray: Ground Glass Pattern AND/OR Peripheral Patches AND/OR Pleural Effusion 2 0
Oxygen Tension less than 95% (ABG) or Oxygen Saturation less than 92% (Pulse Oximeter) 2 0

The following scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available) (Table 1). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient. The scoring system was based on the original scoring system developed by the Saudi Center for Disease Prevention and Control as a byproduct of Saudi Arabia’s long-experience in the management of another coronavirus, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which presented in the year 2012.

In this novel scoring system, shortness of breath/dyspnea was given 2 points because it is the main characteristic of the severe form of COVID-19 [3].

Moreover, cost-effective and accessible investigations such as complete blood picture (CBC) with leucopenia (with or without lymphopenia), ground glass appearance in chest x-ray, and low oxygen saturation below 92% using pulse oximeter were added to the scoring system [2, 3]. The main advantage of these tests (CBC, chest x-ray, and pulse oximeter) is that they are readily available in most primary healthcare/family medicine centers. The new scoring system was used to detect 24 probable cases, of which 17 were confirmed to have COVID-19 (positive PCR and/or characteristic CT chest), with a sensitivity of 70.8% (data not published).

In light of the current COVID-19 pandemic, this score can be adapted and modified as a simple diagnostic system that can be applied both locally or in the WHO region or even globally.

FUNDING

None.

CONFLICT OF INTEREST

The author declares no conflicts of interest, financial or otherwise.

ACKNOWLEDGEMENTS

Declare None.

REFERENCES

[1] Rolling updates on coronavirus disease (COVID-19) Updated 11 March 2020 [(last access March 15, 2020).]; Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
[2] Coronavirus disease [(last access March 15, 2020).]; Available at: https://www.who.int/health-topics/coronavirus
[3] McIntosh K. Coronavirus disease 2019 [(last access March 15, 2020).]; Available at: https: //www.uptodate.com/contents/coronavirus -disease-2019-covid-19
[4] Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 [(last access March 15, 2020).]; (COVID-19). February 14, 2020 https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html
[5] Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020; 296(2): E32-40.