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Table 2 Diagnostic performance indicators for individual COVID-19 symptoms, existing case definitions, and derived compound symptom combinations for a community cohort of 185 people with household COVID-19 exposure in Utah and Wisconsin, United States, March–May 2020

From: Performance of existing and novel surveillance case definitions for COVID-19 in household contacts of PCR-confirmed COVID-19

 

SARS-CoV-2-negative

(n = 136)

SARS-CoV-2-positive

(n = 49)

Specificitya

Sensitivityb

NPVc

PPVd

Youden’s indexe

F-1 scoref

Difference in prevalenceg

 

TNh

FPi

FNj

TPk

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Individual symptoms

 Upper respiratory

  Nasal congestion or rhinorrhea

66

70

5

44

49

(38, 59)

90

(80, 96)

93

(85, 97)

39

(27, 50)

38

(26, 50)

54

(42, 65)

133

(78, 227)

  Sore throat

96

40

22

27

71

(61, 79)

55

(40, 68)

81

(72, 88)

40

(26, 56)

26

(10, 40)

47

(33, 59)

37

(0, 98)

 Lower respiratory

  Cough

103

33

13

36

76

(65, 84)

74

(60, 85)

89

(81, 94)

52

(37, 67)

49

(36, 62)

61

(49, 72)

41

(8, 94)

  Chest pain

122

14

35

14

90

(83, 94)

29

(15, 42)

78

(69, 85)

50

(24, 70)

18

(5, 33)

36

(21, 51)

− 43

(−62, −15)

  Shortness of breath

125

11

36

13

92

(86, 96)

27

(15, 40)

78

(67, 85)

54

(31, 75)

18

(6, 32)

36

(22, 49)

−51

(− 68, − 24)

  Discomfort while breathing

132

4

37

12

97

(93, 99)

25

(14, 39)

78

(69, 85)

75

(40, 92)

22

(10, 36)

37

(22, 54)

−67

(−80, −49)

  Wheezing

133

3

44

5

98

(94, 99)

10

(4, 21)

75

(65, 83)

63

(20, 100)

8

(1, 19)

18

(7, 33)

−84

(−92, −68)

 Neurological

  Headache

86

50

7

42

63

(52, 73)

86

(75, 93)

93

(85, 97)

46

(33, 59)

49

(35, 60)

60

(47, 70)

88

(44, 160)

  Taste and/or smell dysfunction

130

6

18

31

96

(90, 99)

63

(47, 77)

88

(80, 93)

84

(64, 94)

59

(42, 73)

72

(57, 83)

−25

(−43, −5)

 Constitutional

  Fever or chills

113

23

18

31

83

(75, 89)

63

(49, 76)

86

(78, 92)

57

(40, 72)

46

(30, 60)

60

(46, 72)

10

(−15, 51)

  Fatigue

94

42

20

29

69

(59, 79)

59

(41, 74)

83

(74, 89)

41

(25, 57)

28

(10, 44)

48

(33, 63)

45

(8, 106)

  Myalgia

116

20

21

28

85

(77, 91)

57

(42, 70)

85

(77, 90)

58

(41, 74)

42

(28, 56)

58

(44, 69)

−2

(−28, 37)

 Gastrointestinal

  Diarrhea

108

28

31

18

79

(69, 88)

37

(20, 55)

78

(66, 86)

39

(22, 59)

16

(−3, 36)

38

(23, 54)

−6

(−40, 48)

  Abdominal pain

120

16

34

15

88

(80, 94)

31

(19, 45)

78

(68, 85)

48

(27, 73)

19

(4, 35)

38

(23, 53)

−37

(−59, −2)

  Nausea

124

12

40

9

91

(85, 95)

18

(10, 31)

76

(65, 83)

43

(20, 67)

10

(−1, 22)

26

(14, 40)

− 57

(−74, −30)

Existing case definitions

 COVID-19 and respiratory illness surveillance case definitions

  CDC symptom listl

40

96

0

49

29

(17, 45)

100

NAw

100

NA

34

(24, 45)

29

(17, 45)

51

(38, 62)

196

(122, 322)

  ARIm

52

84

2

47

38

(26, 51)

96

(86, 100)

96

(88, 100)

36

(25, 48)

34

(23, 45)

52

(40, 64)

167

(102, 279)

  CSTE combination 1n

79

57

3

46

58

(47, 69)

94

(82, 98)

96

(91, 99)

45

(32, 58)

52

(39, 63)

61

(47, 72)

110

(64, 190)

  CSTE combination 2o

59

77

1

48

43

(35, 52)

98

(88, 100)

98

(90, 100)

38

(30, 47)

41

(32, 50)

55

(46, 64)

155

(110, 225)

  CLIp

93

43

7

42

68

(57, 79)

86

(70, 94)

93

(88, 97)

49

(35, 64)

54

(40, 65)

63

(48, 75)

74

(35, 141)

  ILIq

122

14

24

25

90

(83, 94)

51

(35, 65)

84

(75, 90)

64

(45, 79)

41

(25, 55)

57

(42, 69)

−20

(−41, 9)

Derived compound symptom combinationsr

 Combination 1s

129

7

12

37

95

(89, 98)

76

(60, 87)

92

(85, 96)

84

(67, 94)

70

(54, 82)

80

(67, 88)

−10

(−28, 9)

 Combination 2t

125

11

10

39

92

(84, 97)

80

(65, 89)

93

(86, 96)

78

(59, 91)

72

(56, 83)

79

(66, 88)

2

(−17, 30)

 Combination 3u

126

10

11

38

93

(85, 97)

78

(63, 88)

92

(86, 96)

79

(60, 91)

70

(54, 82)

78

(66, 87)

−2

(−20, 24)

 Combination 4v

129

7

13

36

95

(89, 98)

74

(59, 84)

91

(84, 95)

84

(67, 94)

68

(54, 80)

78

(67, 86)

−12

(−29, 8)

  1. aSpecificity is the probability of testing negative when disease is absent
  2. bSensitivity is the probability of testing positive when disease is present
  3. cNPV negative predictive value. NPV is the probability of a patient not having disease when test is negative
  4. dPPV positive predictive value. PPV is the probability of a patient having disease when test is positive
  5. eYouden’s index is defined as sensitivity plus specificity minus 100 (perfect score = 100)
  6. fF-1 score is defined as the harmonic mean of sensitivity and PPV (perfect score = 100)
  7. gDifference in prevalence is defined as the difference in the number of positive symptom screens (i.e., true positive plus false positive) for each combination from the actual number of contacts who tested positive by RT-PCR
  8. hTN true negative
  9. iFP false positive
  10. jFN false negative
  11. kTP true positive
  12. lU.S. Centers for Disease Control and Prevention (CDC) list of symptoms that may indicate COVID-19 infection (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html). This symptom list was last updated on 13 May 2020
  13. mWorld Health Organization (WHO) acute respiratory infection (ARI) definition for community-based respiratory syncytial virus (RSV) surveillance (https://www.who.int/influenza/rsv/rsv_case_definition/en/). Last updated 04 February 2020
  14. nU.S. Council of State and Territorial Epidemiologists (CSTE) original clinical criteria for COVID-19 reporting (https://cdn.ymaws.com/www.cste.org/resource/resmgr/2020ps/interim-20-id-01_covid-19.pdf). This interim position statement (Interim-20-ID-01) was approved on 05 April 2020 and was replaced by Interim-20-ID-02 on 07 August 2020
  15. oU.S. Council of State and Territorial Epidemiologists (CSTE) revised clinical criteria for COVID-19 reporting (https://cdn.ymaws.com/www.cste.org/resource/resmgr/ps/positionstatement2020/interim-20-id-02_COVID-19.pdf). This interim position statement (Interim-20-ID-02) was approved on 07 August 2020 and replaced Interim-20-ID-01
  16. pU.S. Centers for Disease Control and Prevention (CDC) COVID-19-like illness (CLI) definition was used to guide early diagnostic testing strategies from 17 January 2020–08 March 2020 (https://emergency.cdc.gov/han/han00426.asp)
  17. qInfluenza-like illness (ILI) outpatient visit information collected through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) (https://www.cdc.gov/flu/weekly/overview.htm#anchor_1539281266932). This collaborative effort between CDC, state and local health departments, and healthcare providers has been tracking patients with ILI since the 1997–1998 influenza season
  18. rCompound symptom combinations were derived from all symptoms recorded at any time prior to enrollment (and after the index case’s symptom onset date) through the end of the 14-day observation period
  19. sDerived compound combination 1: Taste and/or smell dysfunction, OR one of the following: shortness of breath, myalgia, or fever or chills
  20. tDerived compound combination 2: Taste and/or smell dysfunction or discomfort breathing, OR at least two of the following: shortness of breath, wheezing, or fever/chills
  21. uDerived compound combination 3: Taste and/or smell dysfunction, OR at least two of the following: shortness of breath, wheezing, discomfort breathing, or fever/chills
  22. vDerived compound combination 4: Taste and/or smell dysfunction, OR shortness of breath and fever/chills
  23. wNA not applicable
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