Clinical and Diagnostic Criteria of COVID 19; a Study of 4659 Patients Evaluating Diagnostic Testing and Establishing an Algorithm

Abstract

Background: COVID 19 is a pandemic that has crippled the world. The disease process started in the Hubei province of China, but has been successfully confirmed in over 170 countries at the time of this article. There does not exist a treatment for this disease. The hallmark of therapy has been early detection, immediate isolation and supportive care. The crux of this management regimen is the early diagnosis of patients. Given the novel nature of this disease, there have been multiple reports attempting to address early diagnosis, however there has yet to be a consensus.

Purpose: The purpose of our study was to review and compile the literature to achieve a large sample size and propose a diagnostic algorithm.

Methods: We reviewed PubMed and Google Scholar and evaluated over 100 articles. 22 articles were chosen, where the diagnosis and diagnostic tests with results were stratified and studied.

Results: There were 4659 patients identified in our data. Clinical symptoms in order of most importance were fever, cough and fatigue. Laboratory data on COVID 19 positive patients included lymphopenia, elevated CRP and elevated ESR. The gold standard in the literature is the RT-PCR, however the accuracy of this test is approximately 60%. CT Chest was sensitive and specific greater than 90% of the time, in particular when coupled with the clinical symptoms.

Discussion: Given the high false negative rate of RT-PCR, and the time component involved in obtaining the results, we proposed an alternative diagnosis pathway. Patients presenting with two of the following clinical symptoms: fever, cough, fatigue, should undergo an immediate CT scan of the chest. Should the classic findings of COVID 19 be appreciated, an immediate working diagnosis of COVID 19 must be entertained. A negative CT chest does not exclude COVID 19, but entails a repeat CT Chest to be performed 48 hours later. The disease has a propensity to peak in symptoms, laboratory findings and imaging close to day 10 of presentation. Until a therapeutic regimen or vaccine is discovered, early diagnosis and isolation remain the mainstay of therapy.