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Study objective We seek to describe the medical history and clinical findings of patients attending the emergency department (ED) with suspected coronavirus disease 2019 (COVID-19) and estimate the diagnostic accuracy of patients' characteristics for predicting COVID-19. Methods We prospectively enrolled all patients tested for severe acute respiratory syndrome coronavirus 2 by reverse-transcriptase polymerase chain reaction in our ED from March 9, 2020, to April 4, 2020. We abstracted medical history, physical examination findings, and the clinical probability of COVID-19 (low, moderate, and high) rated by emergency physicians, depending on their clinical judgment. We assessed diagnostic accuracy of these characteristics for COVID-19 by calculating positive and negative likelihood ratios. Results We included 391 patients, of whom 225 had positive test results for severe acute respiratory syndrome coronavirus 2. Reverse-transcriptase polymerase chain reaction result was more likely to be negative when the emergency physician thought that clinical probability was low, and more likely to be positive when he or she thought that it was high. Patient-reported anosmia and the presence of bilateral B lines on lung ultrasonography had the highest positive likelihood ratio for the diagnosis of COVID-19 (7.58, 95% confidence interval [CI] 2.36 to 24.36; and 7.09, 95% CI 2.77 to 18.12, respectively). The absence of a high clinical probability determined by the emergency physician and the absence of bilateral B lines on lung ultrasonography had the lowest negative likelihood ratio for the diagnosis of COVID-19 (0.33, 95% CI 0.25 to 0.43; and 0.26, 95% CI 0.15 to 0.45, respectively). Conclusion Anosmia, emergency physician estimate of high clinical probability, and bilateral B lines on lung ultrasonography increased the likelihood of identifying COVID-19 in patients presenting to the ED.

Objective: We sought to describe the medical history and clinical findings of patients attending the ED with suspected COVID-19 and estimate the diagnostic accuracy of patients’ characteristics for predicting COVID-19. Methods: We prospectively enrolled all patients tested for SARS-CoV-2 by RT-PCR in our ED from March 9, 2020 to April 4, 2020. We abstracted medical history, physical examination findings, and the clinical probability of COVID-19 (“low”, “moderate”, “high”) rated by emergency physicians depending on their clinical judgment. We assessed diagnostic accuracy of these characteristics for COVID-19 by calculating positive and negative likelihood ratios (LR+/LR-). Results: We included 391 patients of whom 225 tested positive for SARS-CoV-2. RT-PCR was more likely to be negative when the emergency physician thought that clinical probability was low, and more likely to be positive when she or he thought that clinical probability was high. Patient-reported anosmia and the presence of bilateral B-lines on lung ultrasound had the highest LR+ for the diagnosis of COVID-19 (7.58; 95% CI 2.36–24.36 and 7.09; 95% CI 2.77–18.12 respectively). The absence of a high clinical probability determined by the emergency physician and the absence of bilateral B-lines on lung ultrasound had the lowest LR- for the diagnosis of COVID-19 (0.33; 95% CI 0.25–0.43 and 0.26; 95% CI 0.15–0.45 respectively). Conclusions: Anosmia, emergency physician estimate of high clinical probability and bilateral B-lines on lung ultrasound increased the likelihood of identifying COVID-19 in patients presenting to the ED.