Diagnostic yield of screening for SARS-CoV-2 among patients admitted to hospital for alternate diagnoses: an observational cohort study

Philip Davis, Rhonda Rosychuk, Jeffrey P Hau, Ivy Cheng, Andrew D McRae, Raoul Daoust, Eddy Lang, Joel Turner, Jaspreet Khangura, Patrick T Fok, Maja Stachura, Baljeet Brar, Corinne M Hohl, CCEDRRN investigators, and for the Network of Canadian Emergency Researchers and the Canadian Critical Care Trials Group, Philip Davis, Rhonda Rosychuk, Jeffrey P Hau, Ivy Cheng, Andrew D McRae, Raoul Daoust, Eddy Lang, Joel Turner, Jaspreet Khangura, Patrick T Fok, Maja Stachura, Baljeet Brar, Corinne M Hohl, CCEDRRN investigators, and for the Network of Canadian Emergency Researchers and the Canadian Critical Care Trials Group

Abstract

Objectives: To determine the diagnostic yield of screening patients for SARS-CoV-2 who were admitted with a diagnosis unrelated to COVID-19 and to identify risk factors for positive tests.

Design: Cohort from the Canadian COVID-19 Emergency Department Rapid Response Network registry.

Setting: 30 acute care hospitals across Canada.

Participants: Patients hospitalised for non-COVID-19-related diagnoses who were tested for SARS-CoV-2 between 1 March and 29 December 2020.

Main outcome: Positive nucleic acid amplification test for SARS-CoV-2.

Outcome measure: Diagnostic yield.

Results: We enrolled 15 690 consecutive eligible adults who were admitted to hospital without clinically suspected COVID-19. Among these patients, 122 tested positive for COVID-19, resulting in a diagnostic yield of 0.8% (95% CI 0.64% to 0.92%). Factors associated with a positive test included presence of fever, being a healthcare worker, having a positive household contact or institutional exposure, and living in an area with higher 7-day average incident COVID-19 cases.

Conclusions: Universal screening of hospitalised patients for COVID-19 across two pandemic waves had a low diagnostic yield and should be informed by individual-level risk assessment in addition to regional COVID-19 prevalence.

Trial registration number: NCT04702945.

Keywords: COVID-19; Diagnostic microbiology; EPIDEMIOLOGY; Organisation of health services.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Patient flow diagram. ED, emergency department.
Figure 2
Figure 2
The 7-day working average of COVID-19 NAAT positivity over the study period across sites. NAAT, nucleic acid amplification test.
Figure 3
Figure 3
Diagnostic yield by presenting symptoms.
Figure 4
Figure 4
Diagnostic yield by ED diagnosis. ED, emergency department; NYD, not yet determined.

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Source: PubMed

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