Scoring System for the Diagnosis of COVID-19
Mohamed Farouk Allam1, *
Identifiers and Pagination:Year: 2020
First Page: 413
Last Page: 414
Publisher Id: TOPHJ-13-413
Article History:Received Date: 18/4/2020
Acceptance Date: 18/4/2020
Electronic publication date: 18/08/2020
Collection year: 2020
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.
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.
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 .
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 . 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 . A recent study reported that some patients with positive chest CT findings might present with negative results of RT-PCR for COVID-19 .
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.
|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.
|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).
|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|
|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 .
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.
CONFLICT OF INTEREST
The author declares no conflicts of interest, financial or otherwise.
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|||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|
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