Background: Detecting and isolating cases of COVID-19 are amongst the key elements listed by the WHO to reduce transmission. This approach has been reported to reduce those symptomatic with COVID-19 in the population by over 90%. Testing is part of a strategy that will save lives. Testing everyone maybe ideal, but it is not practical. A risk tool based on patient demographics and clinical parameters has the potential to help identify patients most likely to test negative for SARS-CoV-2. If effective it could be used to aide clinical decision making and reduce the testing burden. Methods: At the time of this analysis, a total of 9,516 patients with symptoms suggestive of Covid-19, were assessed and tested at Mount Sinai Institutions in New York. Patient demographics, clinical parameters and test results were collected. A robust prediction pipeline was used to develop a risk tool to predict the likelihood of a positive test for Covid-19. The risk tool was analyzed in a holdout dataset from the cohort and its discriminative ability, calibration and net benefit assessed. Results: Over 48% of those tested in this cohort, had a positive result. The derived model had an AUC of 0.77, provided reliable risk prediction, and demonstrated a superior net benefit than a strategy of testing everybody. When a risk cut-off of 70% was applied, the model had a negative predictive value of 96%. Conclusion: Such a tool could be used to help aide but not replace clinical decision making and conserve vital resources needed to effectively tackle this pandemic.
【저자키워드】 COVID-19, risk prediction, SARS–CoV-2, Resource allocation, clinical decision aid, 【초록키워드】 SARS-CoV-2, pandemic, risk, Transmission, Symptom, Cohort, Testing, symptomatic, Patient, dataset, New York, resource, predict, Analysis, Negative predictive value, AUC, demographics, Mount Sinai, institution, positive result, help, clinical decision, Positive test, cut-off, element, clinical parameter, over, approach, effective, benefit, likelihood, robust, tested, analyzed, identify, was used, collected, develop, reported, provided, applied, demonstrated, reduce, the WHO, test negative, were assessed, with COVID-19, 【제목키워드】 Test, Triage, Testing, burden, negative, System, Result,