Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease

Summary

This Cochrane systematic review synthesised evidence on the diagnostic accuracy of clinical signs and symptoms for identifying COVID-19 in primary care and outpatient settings as of April 2020. The review found that most individual signs and symptoms had poor diagnostic accuracy for ruling in or ruling out COVID-19, although anosmia and ageusia may serve as useful red flags, and fever and cough—due to high sensitivity—may help identify patients warranting further testing. The authors noted substantial heterogeneity and selection bias in available studies and called for prospective research examining symptom combinations in unselected populations.

UK applicability

The findings are directly applicable to UK primary care and emergency department practice, where similar symptoms are used for initial COVID-19 triage and testing decisions. The review's conclusion that individual symptoms lack sufficient accuracy supports the UK's adoption of rapid diagnostic testing and clinical algorithms rather than reliance on symptom assessment alone.

Key measures

Sensitivity and specificity of signs and symptoms; diagnostic accuracy measures; likelihood ratios

Outcomes reported

The study assessed the diagnostic accuracy of signs and symptoms (such as fever, cough, anosmia, ageusia, oxygen saturation) to determine COVID-19 disease or COVID-19 pneumonia in patients presenting to primary care or hospital outpatient settings. Sensitivity, specificity, and predictive values of individual and combined signs and symptoms were evaluated across multiple studies.

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