Abstract
Background: Coronavirus disease 2019 (COVID-19) testing policies for symptomatic children attending US schools or daycare vary, and whether isolated symptoms should prompt testing is unclear. We evaluated children presenting for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing to determine if the likelihood of having a positive SARS-CoV-2 test differed between participants with 1 symptom vs ≥2 symptoms, and to examine the predictive capability of isolated symptoms.
Methods: Participants aged <18 years presenting for clinical SARS-CoV-2 molecular testing in 6 sites in urban/suburban/rural Georgia (July-October, 2021; Delta variant predominant) were queried about individual symptoms. Participants were classified into 3 groups: asymptomatic, 1 symptom only, or ≥2 symptoms. SARS-CoV-2 test results and clinical characteristics of the 3 groups were compared. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) for isolated symptoms were calculated by fitting a saturated Poisson model.
Results: Of 602 participants, 21.8% tested positive and 48.7% had a known or suspected close contact. Children reporting 1 symptom (n = 82; odds ratio [OR], 6.00 [95% confidence interval {CI}, 2.70-13.33]) and children reporting ≥2 symptoms (n = 365; OR, 5.25 [95% CI, 2.66-10.38]) were significantly more likely to have a positive COVID-19 test than asymptomatic children (n = 155), but they were not significantly different from each other (OR, 0.88 [95% CI, .52-1.49]). Sensitivity and PPV were highest for isolated fever (33% and 57%, respectively), cough (25% and 32%), and sore throat (21% and 45%); headache had low sensitivity (8%) but higher PPV (33%). Sensitivity and PPV of isolated congestion/rhinorrhea were 8% and 9%, respectively.
Conclusions: With high Delta variant prevalence, children with isolated symptoms were as likely as those with multiple symptoms to test positive for COVID-19. Isolated fever, cough, sore throat, or headache, but not congestion/rhinorrhea, offered the highest predictive value.
Keywords: COVID-19; SARS-CoV-2; children; symptom; testing.
【저자키워드】 COVID-19, SARS-CoV-2, children, Symptom, testing., 【초록키워드】 Coronavirus disease 2019, coronavirus, Clinical characteristics, cough, headache, delta variant, Symptoms, Prevalence, sensitivity, specificity, Positive predictive value, Asymptomatic, symptomatic, Fever, School, molecular, group, close contact, Odds ratio, Negative predictive value, Predictive, sore throat, confidence interval, acute respiratory syndrome, Participants, participant, positive, SARS-CoV-2 test, positive COVID-19, likelihood, individual symptoms, highest, tested, significantly more, evaluated, calculated, determine, predominant, presenting, Isolated, saturated, not significantly different, offered, Poisson model, PPV, 【제목키워드】 Delta, coronavirus 2, respiratory, peak, value, Isolated,