Kline, Jeffrey A.Camargo, Carlos A.Courtney, D. MarkKabrhel, ChristopherNordenholz, Kristen E.Aufderheide, ThomasBaugh, Joshua J.Beiser, David G.Bennett, Christopher L.Bledsoe, JosephCastillo, EdwardChisolm-Straker, MakiniGoldberg, Elizabeth M.House, HansHouse, StaceyJang, TimothyLim, Stephen C.Madsen, Troy E.McCarthy, Danielle M.Meltzer, AndrewMoore, StephenNewgard, CraigPagenhardt, JustinePettit, Katherine L.Pulia, Michael S.Puskarich, Michael A.Southerland, Lauren T.Sparks, ScottTurner-Lawrence, DanielleVrablik, MarieWang, AlfredWeekes, Anthony J.Westafer, LaurenWilburn, John2021-03-182021-03-182021-03Kline, J. A., Camargo Jr, C. A., Courtney, D. M., Kabrhel, C., Nordenholz, K. E., Aufderheide, T., ... & Wilburn, J. (2021). Clinical prediction rule for SARS-CoV-2 infection from 116 US emergency departments 2-22-2021. Plos one, 16(3), e0248438. https://doi.org/10.1371/journal.pone.0248438https://hdl.handle.net/1805/25415Objectives Accurate and reliable criteria to rapidly estimate the probability of infection with the novel coronavirus-2 that causes the severe acute respiratory syndrome (SARS-CoV-2) and associated disease (COVID-19) remain an urgent unmet need, especially in emergency care. The objective was to derive and validate a clinical prediction score for SARS-CoV-2 infection that uses simple criteria widely available at the point of care. Methods Data came from the registry data from the national REgistry of suspected COVID-19 in EmeRgency care (RECOVER network) comprising 116 hospitals from 25 states in the US. Clinical variables and 30-day outcomes were abstracted from medical records of 19,850 emergency department (ED) patients tested for SARS-CoV-2. The criterion standard for diagnosis of SARS-CoV-2 required a positive molecular test from a swabbed sample or positive antibody testing within 30 days. The prediction score was derived from a 50% random sample (n = 9,925) using unadjusted analysis of 107 candidate variables as a screening step, followed by stepwise forward logistic regression on 72 variables. Results Multivariable regression yielded a 13-variable score, which was simplified to a 13-point score: +1 point each for age>50 years, measured temperature>37.5°C, oxygen saturation<95%, Black race, Hispanic or Latino ethnicity, household contact with known or suspected COVID-19, patient reported history of dry cough, anosmia/dysgeusia, myalgias or fever; and -1 point each for White race, no direct contact with infected person, or smoking. In the validation sample (n = 9,975), the probability from logistic regression score produced an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.79–0.81), and this level of accuracy was retained across patients enrolled from the early spring to summer of 2020. In the simplified score, a score of zero produced a sensitivity of 95.6% (94.8–96.3%), specificity of 20.0% (19.0–21.0%), negative likelihood ratio of 0.22 (0.19–0.26). Increasing points on the simplified score predicted higher probability of infection (e.g., >75% probability with +5 or more points). Conclusion Criteria that are available at the point of care can accurately predict the probability of SARS-CoV-2 infection. These criteria could assist with decisions about isolation and testing at high throughput checkpoints.enAttribution 4.0 InternationalSARS-CoV-2COVID-19virus testingArticle