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Table 3 Diagnostic performance indicators for individual COVID-19 symptoms, existing case definitions, and derived compound symptom combinations by age group for 122 adults and 63 children with household exposure to COVID-19 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

 

Adults

Children

Differencee

 

Specificitya

Sensitivityb

Youden’s indexc

F-1 scored

Specificity

Sensitivity

Youden’s index

F-1 score

Specificity

Sensitivity

 

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)

Value

(95% CI)f

Value

(95% CI)f

Individual symptoms

 Upper respiratory

  Nasal congestion or rhinorrhea

40

(30, 51)

91

(78, 97)

32

(17, 44)

54

(40, 66)

63

(44, 77)

86

(58, 100)

49

(25, 67)

55

(32, 71)

−23

(− 44, 2)

6

(−13, 31)

  Sore throat

61

(50, 72)

51

(33, 68)

12

(−9, 31)

41

(26, 56)

88

(74, 96)

64

(29, 88)

52

(21, 78)

62

(35, 82)

−27

(−43, − 9)

−13

(− 47, 28)

 Lower respiratory

  Cough

68

(56, 78)

86

(71, 94)

54

(37, 68)

65

(51, 76)

90

(77, 96)

43

(13, 77)

33

(3, 68)

48

(18, 75)

−22

(−39, −5)

43

(2, 78)

  Chest pain

84

(74, 91)

34

(18, 52)

18

(0, 38)

39

(22, 57)

100

NAr

14

(0, 29)

14

(0, 29)

25

(11, 40)

−16

(−27, −8)

20

(−6, 45)

  Shortness of breath

89

(80, 94)

29

(16, 44)

17

(2, 34)

36

(21, 52)

98

(87, 100)

21

(0, 56)

19

(−2, 56)

33

(11, 63)

−9

(−20, 0)

7

(−33, 38)

  Discomfort while breathing

95

(90, 99)

29

(13, 48)

24

(8, 43)

41

(21, 61)

100

NA

14

(0, 29)

14

(0, 29)

25

(11, 40)

−5

(−10, −1)

14

(−10, 40)

  Wheezing

97

(91, 99)

11

(3, 25)

8

(−1, 21)

19

(6, 37)

100

(100, 100)

7

(0, 33)

7

(0, 33)

13

(6, 18)

−3

(−9, 0)

4

(−18, 18)

 Neurological

  Headache

54

(43, 65)

86

(71, 94)

40

(24, 53)

57

(44, 68)

80

(63, 90)

86

(63, 100)

65

(47, 81)

67

(44, 81)

−26

(−44, −4)

0

(−21, 24)

  Taste and/or smell dysfunction

95

(89, 99)

71

(51, 85)

67

(47, 82)

78

(63, 88)

96

(84, 100)

43

(18, 67)

39

(13, 65)

55

(29, 76)

−1

(−8, 10)

29

(−3, 58)

 Constitutional

  Fever or chills

82

(72, 89)

63

(46, 78)

45

(27, 61)

60

(46, 73)

86

(68, 95)

64

(33, 90)

50

(14, 78)

60

(30, 82)

−4

(−20, 16)

−1

(−36, 37)

  Fatigue

59

(47, 70)

63

(43, 78)

22

(1, 40)

47

(32, 61)

88

(71, 96)

50

(9, 80)

38

(1, 72)

52

(19, 79)

−29

(−48, −8)

13

(−32, 60)

  Myalgia

79

(69, 87)

63

(45, 77)

42

(24, 58)

59

(44, 71)

96

(85, 100)

43

(11, 69)

39

(10, 64)

55

(23, 75)

−17

(−29, −4)

20

(−19, 62)

 Gastrointestinal

  Diarrhea

82

(71, 90)

40

(19, 60)

22

(0, 43)

43

(23, 62)

76

(55, 89)

29

(8, 60)

4

(−24, 37)

27

(10, 47)

6

(−13, 30)

11

(−27, 46)

  Abdominal pain

89

(80, 94)

37

(21, 54)

26

(8, 44)

45

(27, 61)

88

(73, 97)

14

(0, 57)

2

(−17, 39)

18

(7, 45)

1

(−13, 17)

23

(−20, 49)

  Nausea

92

(85, 96)

17

(6, 32)

9

(−3, 25)

25

(10, 43)

90

(77, 96)

21

(4, 62)

11

(−11, 50)

27

(9, 57)

2

(−8, 15)

−4

(−48, 23)

Existing case definitions

 COVID-19 and respiratory illness surveillance case definitions

  CDC symptom listg

21

(13, 32)

100

NA

21

(13, 32)

50

(38, 63)

45

(22, 65)

100

NA

45

(22, 65)

51

(29, 68)

−24

(−50, 6)

NA

NA

  ARIh

29

(19, 41)

100

NA

29

(19, 41)

53

(40, 65)

55

(34, 72)

86

(58, 100)

41

(17, 60)

50

(29, 68)

−26

(−50, 0)

14

(0, 38)

  CSTE combination 1i

46

(34, 58)

97

(81, 100)

43

(30, 55)

59

(45, 70)

80

(63, 91)

86

(43, 100)

65

(33, 83)

67

(38, 84)

−34

(− 53, −12)

11

(−7, 45)

  CSTE combination 2j

36

(26, 46)

97

(84, 100)

33

(20, 44)

54

(44, 65)

57

(43, 70)

100

NA

57

(43, 70)

57

(39, 72)

−22

(−43, 0)

−3

(−14, 0)

  CLIk

61

(48, 73)

91

(78, 98)

52

(36, 66)

63

(49, 76)

82

(64, 92)

71

(20, 95)

53

(8, 80)

61

(26, 83)

−21

(−41, 2)

20

(−10, 71)

  ILIl

86

(76, 93)

54

(37, 70)

41

(23, 59)

58

(42, 71)

96

(85, 100)

43

(11, 80)

39

(7, 78)

55

(20, 85)

−10

(− 22, 2)

11

(−36, 53)

Derived compound symptom combinationsm

 

 Combination 1n

94

(88, 98)

83

(64, 94)

77

(58, 89)

84

(70, 92)

96

(84, 100)

57

(22, 83)

53

(17, 81)

67

(29, 86)

−2

(−10, 9)

26

(− 10, 64)

 Combination 2o

90

(81, 96)

86

(67, 96)

75

(56, 87)

81

(67, 90)

96

(84, 100)

64

(38, 85)

60

(31, 83)

72

(43, 89)

−6

(−17, 5)

21

(−10, 51)

 Combination 3p

91

(82, 96)

83

(64, 94)

74

(55, 86)

81

(66, 90)

96

(84, 100)

64

(38, 85)

60

(31, 83)

72

(43, 89)

−5

(−15, 5)

19

(−14, 49)

 Combination 4q

94

(88, 98)

83

(64, 94)

77

(58, 89)

84

(70, 92)

96

(84, 100)

50

(17, 67)

46

(16, 69)

61

(30, 80)

−2

(−10, 9)

33

(3, 66)

  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. cYouden’s index is defined as sensitivity plus specificity minus 100 (perfect score = 100)
  4. dF-1 score is defined as the harmonic mean of sensitivity and positive predictive value (perfect score = 100)
  5. eDifference in specificity and sensitivity between adults and children
  6. fConfidence intervals are jointly 95%, or 97.5% with a Bonferroni correction
  7. gU.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
  8. hWorld 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
  9. iU.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
  10. jU.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
  11. kU.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)
  12. lInfluenza-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
  13. mCompound 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 two-week observation period
  14. nCombination 1: Taste and/or smell dysfunction, OR one of the following: shortness of breath, myalgia, or fever or chills
  15. oCombination 2: Taste and/or smell dysfunction or discomfort breathing, OR at least two of the following: shortness of breath, wheezing, or fever/chills
  16. pCombination 3: Taste and/or smell dysfunction, OR at least two of the following: shortness of breath, wheezing, discomfort breathing, or fever/chills
  17. qCombination 4: Taste and/or smell dysfunction, OR shortness of breath and fever/chills
  18. rNA = not applicable
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