Predictive Value of Isolated Symptoms for Diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children Tested During Peak Circulation of the Delta Variant

• Type of Material: Article
• Authors: Adrianna L. Westbrook, Emory University; Laura C. Benedit, Childrens Healthcare Atlanta; Jennifer K. Frediani, Emory University; Mark Griffiths, Emory University; Nabeel Y. Khan, Emory University; Joshua Levy, Emory University; Claudia Morris, Emory University; Christina Rostad, Emory University; Cheryl L. Stone, Childrens Healthcare Atlanta; Julie Sullivan, Emory University; Miriam Vos, Emory University; Jean Welsh, Emory University; Anna Wood, Emory University; Gregory Martin, Emory University; Wilbur Lam, Emory University; Nira R. Pollock, Boston Children's Hospital
• Language: English
• Date: 2022-05-11
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciac112
• Title of Journal or Parent Work: CLINICAL INFECTIOUS DISEASES
• Keywords: testing; Immunology; Life Sciences & Biomedicine; symptom; SARS-CoV-2; Infectious Diseases; COVID-19; Science & Technology; Microbiology; children
• Research Categories: Biology, Virology; Biology, Microbiology; Health Sciences, Immunology

Abstract

BACKGROUND: COVID-19 testing policies for symptomatic children attending U.S. schools or daycare vary, and whether isolated symptoms should prompt testing is unclear. We evaluated children presenting for SARS-CoV-2 testing to determine if the likelihood of having a positive SARS-CoV-2 test differed between participants with one versus ≥2 symptoms, and to examine the predictive capability of isolated symptoms. METHODS: Participants ≤ 18 years presenting for clinical SARS-CoV-2 molecular testing in six sites in urban/suburban/rural Georgia (July-October, 2021; delta variant predominant) were queried about individual symptoms. Participants were classified into three groups: asymptomatic, one symptom only, or ≥2 symptoms. SARS-CoV-2 test results and clinical characteristics of the three groups were compared. Sensitivity, specificity, and positive/negative predictive values (PPV/NPV) for isolated symptoms were calculated by fitting a saturated Poisson model. RESULTS: Of 602 participants, 21.8% tested positive and 48.7% had a known or suspected close contact. Children reporting one symptom (n=82; OR=6.00, 95% CI: 2.70-13.33) and children reporting ≥2 symptoms (n=365; OR=5.25: 2.66-10.38) were significantly more likely to have a positive COVID-19 test than asymptomatic children (n=155), but they were not significantly different from each other (OR=0.88: 0.52-1.49). Sensitivity/PPV were highest for isolated fever (33%/57%), cough (25%/32%), and sore throat (21%/45%); headache had low sensitivity (8%) but higher PPV (33%). Sensitivity/PPV of isolated congestion/rhinorrhea were 8%/9%. CONCLUSIONS: With high delta variant prevalence, children with isolated symptoms were as likely as those with multiple symptoms to test positive for COVID-19. Isolated fever, cough, sore throat, or headache, but not congestion/rhinorrhea, offered highest predictive value.