Diagnostic Accuracy of Clinical Gestalt of Doctors with Different Experiences in COVID-19 Suspected Patients

Abstract

Abstract This study aim is to evaluate the ability of physicians' predictions to predict mortality in COVID-19 patients, as well as to compare physician predictions with scores developed for COVID-19 patients in predicting mortality and patient worsening. This study was conducted prospectively in the emergency department. Patient data were collected between 20.03.2021 and 20.06.2021. Patients who applied to our hospital with COVID-19 symptoms and were confirmed to be COVID-19 by rt-PCR results were included in our study. Patients aged 18 years and over who were tr-PCR positive were included in the study. Quick COVID-19 Severity Index (qCSI), Brescia-COVID Respiratory Severity Scale (BCRSS) and CURB-65 scale were calculated and recorded by a researcher. A total of 176 patients were included in our study. There was no significant relationship between physicians' gestalt and 28-day mortality (p=0.121, p=0.282, Mann-Whitney U Test, respectively). Physicians' gestalt was found to be insufficient to predict mortality in COVID-19 patients. there was a significant difference between the CURB-65 short-term mortality group and the survivors. Keywords: COVID-19, Gestalt, CURB-65, mortality

Keywords

• COVID-19
• Gestalt
• CURB-65
• mortality

References

1. 1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5. Epub 2020 Jan 24. Erratum in: Lancet. 2020 Jan 30;: PMID: 31986264; PMCID: PMC7159299.
2. 2. Giacomelli A, Ridolfo AL, Milazzo L, Oreni L, Bernacchia D, Siano M, et al. 30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: A prospective cohort study. Pharmacol Res. 2020 Aug;158:104931. doi: 10.1016/j.phrs.2020.104931. Epub 2020 May 22. PMID: 32446978; PMCID: PMC7242199.
3. 3. Rodriguez-Nava G, Yanez-Bello MA, Trelles-Garcia DP, Chung CW, Friedman HJ, Hines DW. Performance of the quick COVID-19 severity index and the Brescia-COVID respiratory severity scale in hospitalized patients with COVID-19 in a com-munity hospital setting. Int J Infect Dis. 2021 Jan;102:571-576. doi: 10.1016/j.ijid.2020.11.003. Epub 2020 Nov 9. PMID: 33181332; PMCID: PMC7833674.
4. 4. Soto-Mota A, Marfil-Garza BA, Castiello-de Obeso S, Martinez Rodriguez EJ, Carril-lo Vazquez DA, Tadeo-Espinoza H, et al. Prospective predictive per-formance comparison between clinical gestalt and validated COVID-19 mortality scores. J Investig Med. 2022 Feb;70(2):415-420. doi: 10.1136/jim-2021-002037. Epub 2021 Oct 7. PMID: 34620707; PMCID: PMC8507412.
5. 5. Özdemir S, Akça HŞ, Algın A, Altunok İ, Eroğlu SE. Effectiveness of the rapid emergency medicine score and the rapid acute physiology score in prognosticating mortality in patients presenting to the emergency department with COVID-19 symptoms. Am J Emerg Med. 2021 Nov;49:259-264. doi: 10.1016/j.ajem.2021.06.020. Epub 2021 Jun 10. PMID: 34171720; PMCID: PMC8191303
6. 6. Bradley J, Sbaih N, Chandler TR, Furmanek S, Ramirez JA, Cavallazzi R. Pneumonia Severity Index and CURB-65 Score Are Good Predictors of Mortality in Hospitalized Patients With SARS-CoV-2 Community-Acquired Pneumonia. Chest. 2021;S0012-3692(21)04257-4. doi:10.1016/j.chest.2021.10.031
7. 7. Akça HŞ, Algın A, Özdemir S, Sevimli H, Kokulu K, Eroğlu SE. Comparison of the efficacy of PSI, CURB-65, CALL and BCRSS in predicting prognosis and mortality in COVID-19 patients. J. Exp. Clin. Med.. 2021; 38(4): 434-439.
8. 8. Solaymani-Dodaran M, Ghanei M, Bagheri M, Qazvini A, Vahedi E, Hassan Saadat S, et al. Safety and efficacy of Favi-piravir in moderate to severe SARS-CoV-2 pneumonia. Int Immunopharmacol. 2021 Jun;95:107522. doi: 10.1016/j.intimp.2021.107522. Epub 2021 Mar 11. PMID: 33735712; PMCID: PMC7951885.

9. 9. Cappanera S, Palumbo M, Kwan SH, Priante G, Martella LA, Saraca LM, et al. When Does the Cytokine Storm Begin in COVID-19 Patients? A Quick Score to Recognize It. J Clin Med. 2021 Jan 15;10(2):297. doi: 10.3390/jcm10020297. PMID: 33467466; PMCID: PMC7830161.
10. 10. Popadic V, Klasnja S, Milic N, Rajovic N, Aleksic A, Milenkovic M, et al. Predictors of Mortality in Critically Ill COVID-19 Patients Demanding High Oxygen Flow: A Thin Line between Inflam-mation, Cytokine Storm, and Coagulopathy. Oxid Med Cell Longev. 2021 Apr 20;2021:6648199. doi: 10.1155/2021/6648199. PMID: 33968298; PMCID: PMC8081622.
11. 11. Gungor B, Atici A, Baycan OF, Alici G, Ozturk F, Tugrul S,et al. Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis. Am J Emerg Med. 2021 Jan;39:173-179. doi: 10.1016/j.ajem.2020.09.018. Epub 2020 Sep 14. PMID: 33069541; PMCID: PMC7489326.