COVID-19 digital ‘signal analyzers’ may prevent some patients from receiving prompt treatment for a serious illness, suggests an international case simulation study, published in the journal online BMJ Health & Care Informatics.
Both U.S. and UK symptom testers have consistently failed to detect symptoms of COVID-19 deficiency, bacterial overgrowth, and sepsis, often advising these cases to stay at home, the co. conclusions inform.
The availability of symptom testers is growing, and they are currently being used nationally to treat COVID-19 infection.
It is difficult to identify which patients with COVID-19 require treatment, because the disease can be similar to common conditions that rarely require medical attention and because there are no clinical signs or symptoms. in which reliably predicts who will progress to a real disease, note the researchers.
Digital signal testers combine a series of set questions and preset answers to advise an individual on the most appropriate course of action.
But so far, there is almost no evidence for the efficacy or safety of symptom testers to prioritize treatment (testing) during a pandemic, the researchers said.
So they looked at the ability of digital signal testers with the support of national governments in Singapore, Japan, the US and the UK, to properly recruit people who need medical assessment and / or treatment.
Signals included: the Singapore COVID-19 Symptom Checker; Disable COVID-19 Symptom Checker (Japan); CDC Coronavirus Symptom Checker (US); and 111 COVID-19 Symptom Detector (UK).
COVID-19 mortality rates in Singapore and Japan are very low; in the US and UK they are relatively high.
The researchers wanted to see if the investigators were able to differentiate moderate symptoms from COVID-19 malignancy, and how well they picked up COVID-19 mimickers such as bacterial pneumonia and sepsis in 52 typical case conditions. .
The cases mimicked common signs / symptoms associated with COVID-19 of various risk factors and factors. These included: cough and fever; stable condition (high blood pressure) as well as cough and fever; immunity is suppressed as a result of drug treatment as well as cough and fever; and shortness of breath and fever.
These four specific manifestations were then modified in terms of one or more of the following: how long since symptoms began; patient age; and signal depth.
The signal analysts in Singapore and Japan tested twice as many cases for direct clinical evaluation as the signal testers in the US and the UK.
Singapore had the highest overall referral rate at 88%; the U.S. had the lowest at 38%. Among the symbolic cases that were not included, the US and UK attempted a large number that would typically require early clinical assessment to ‘stay at home’.
A U.S. symptom analyst would often test for typical cases with severe COVID-19, severe bacterial infection, and sepsis to stay at home and neutropenic sepsis (low white cell count after chemotherapy) to seek medical attention alongside -in 24 hours.
A UK symptom examiner would frequently test for COVID-19 and bacterial pneumonia that could stay at home without any follow-up and appears to have delayed treatment for sepsis, COVID-19 severe, and severe sepsis, the researchers note.
While Japan’s symptom tester did well overall, the simulation revealed a potential delay in treatment for very severe sepsis. And none of the researchers tested a typical neutropenic sepsis symptom to emergency care.
The researchers test the UK’s signal analysis engine for its complex algorithm, and for testing for symptoms such as shortness of breath and the severity of the disease by asking questions thematic, qualitative with multiple-choice responses.
The questions used to differentiate between levels of anxiety are not up to the task, they suggest.
Both U.S. and UK symptom testers are “likely to delay manifestations of poor health conditions to appropriate care, and therefore, are more likely to be at increased risk of morbidity and mortality,” they note. warning.
“Both symptom testers maintain a high threshold for referral to clinical communication, trying to get most patients to stay at home with no clinical connection. ”
The researchers acknowledge that by reducing physical connections, signal testers can save valuable resources and reduce viral transmission, and require fewer resources than telephone and telemedicine testing services.
However, their findings suggest that “while ‘signal testers’ may be useful for the COVID-19 healthcare response, there is potential for patient-led assessment tools to reduce outcomes by reducing ‘delay appropriate clinical assessment, “especially if used as the sole source of medical advice, they conclude.
“Our results support the recommendation that signal testers should be subject to the same level of evidence-based quality assurance as other diagnostic tests prior to implementation,” they add.
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External peer review? there is
Type of evidence: Case implication study
Subjects: COVID-19 symptom investigators
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