Optimizing COVID-19 Symptom Screening in the Pediatric Population

Background: Research analyzing COVID-19 symptom screening has primarily focused on adult patients. In efforts to safely reopen schools, symptom screeners are being widely utilized. However, pediatric-specific outpatient data on which symptom combinations best identify children with COVID-19 are lacking. Such data could refine school symptom screening by improving screener sensitivity and specificity. In this study, we assessed the frequency of symptoms and symptom combinations in children tested for SARS-CoV-2 in outpatient settings. We aim to contribute to the optimization of pediatric COVID-19 screening questionnaires, to ultimately minimize both COVID-19 transmission in schools and missed school days. Methods: We conducted a retrospective analysis of outpatient symptoms screens, SARS-CoV-2 test results, and demographics of children (≤18 years) tested for SARS-CoV-2 between March 30 and November 30, 2020, at 3 UCSF-affiliated COVID-19 outpatient screening clinics in northern California. Those with incomplete symptom screens, >7 days between symptom documentation and test, and invalid test results were excluded. Results: Of 473 children tested at 1 site, 21 children had positive SARs-CoV-2 results and 452 children had negative results (4.4% positivity rate). Moreover, 85.7% of SARS-CoV-2–positive children had a known exposure to COVID-19 (Table 1). Of SARS-CoV-2–positive children, 61.9% had >1 symptom. Also, 52.4% of SARS-CoV-2–positive children had at least 1 symptom (fever, cough, or loss of taste or smell) versus 62.8% of SARS-CoV-2–negative children (Table 2). Runny nose or nasal congestion was the most frequently reported symptom in the SARS-CoV-2–positive group (47.6%) as well as the SARS-CoV-2–negative group (58.6%). Also, 14.3% of SARS-CoV-2–positive children had eye redness or discharge versus 3.1% of SARS-CoV-2–negative children. Isolated runny nose presented in 10.8% of SARS-CoV-2–negative versus 9.5% of SARS-CoV-2–positive children. All children with isolated diarrhea (n = 5), isolated headache (n = 3), and isolated rash (n = 2) tested negative. Preliminary symptom data based on 176 children from a second site showed that 9.9% of symptomatic children had a positive test result. Conclusions: Runny nose or nasal congestion was the most frequently reported symptom in all children tested for SARS-CoV-2. However, isolated runny nose or nasal congestion identified 2 cases of COVID-19 in our cohort. Eye redness or discharge may be an important symptom to screen for COVID-19 in children. Further research with a larger number of positive cases is needed to make conclusions about improving efficiency and efficacy of symptom screeners for COVID-19 in children.Funding: NoDisclosures: None

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Centrifugation may eliminate false-positive leucocyte esterase strip test results caused by inflammatory arthritis in the diagnosis of knee infection

Bone and Joint Research ◽

10.1302/2046-3758.95.bjr-2019-0245.r1 ◽

2020 ◽

Vol 9 (5) ◽

pp. 236-241

Author(s):

Rui Li ◽

Chi Wang ◽

Xiao-Jian Ji ◽

Qing-Yuan Zheng ◽

Xiang Li ◽

...

Keyword(s):

False Positive ◽

Inflammatory Arthritis ◽

Test Results ◽

Knee Infection ◽

Negative Results ◽

Before And After ◽

Strip Test ◽

Positive Results ◽

Test Result ◽

Colour Chart

Aims The purpose of this study was to validate our hypothesis that centrifugation may eliminate false-positive leucocyte esterase (LE) strip test results caused by autoimmune diseases in the diagnosis of knee infection. Methods Between January 2016 and May 2019, 83 cases, including 33 cases of septic arthritis and 50 cases of aseptic arthritis, were enrolled in this study. To further validate our hypothesis, another 34 cases of inflammatory arthritis from the Department of Rheumatology of our institution were also included. After aspiration, one drop of synovial fluid was applied to LE strips before and after centrifugation. The results were recorded after approximately three minutes according to the different colour grades on the colour chart. The differences of LE results between each cohort were analyzed. Results Before centrifugation, 46% (23/50) of the LE strip tests in the aseptic arthritis group were false-positives. Most of the false-positive results were due to inflammatory arthritis; after centrifugation, 78.3% (18/23) of the tests yielded negative results. Similar results were observed in cases from the Department of Rheumatology. The sensitivity of the centrifuged LE strip test was 0.818 (0.639 to 0.924), which is still an acceptable level compared with the uncentrifuged results, which yielded a sensitivity of 0.909 (0.745 to 0.976). However, the specificity was increased from 0.540 (0.395 to 0.679) to 0.900 (0.774 to 0.963) after centrifugation. Conclusion Although inflammatory arthritis can yield a false-positive LE strip test result in the diagnosis of knee infection, centrifugation may eliminate these false-positive results. Cite this article: Bone Joint Res. 2020;9(5):236–241.

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Long-Term Follow-Up in Children with Anisocoria: Cocaine Test Results and Patient Outcome

Journal of Ophthalmology ◽

10.1155/2017/7575040 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Fabienne C. Fierz ◽

Christina Gerth-Kahlert

Keyword(s):

Pediatric Population ◽

Horner’S Syndrome ◽

Surgical Trauma ◽

Test Results ◽

Horner's Syndrome ◽

Tertiary Referral Centre ◽

Long Term Follow Up ◽

Test Result

Background. Evaluation of anisocoria including pharmacological testing for Horner’s syndrome in the pediatric population is challenging in view of potential serious underlying disease. We describe cocaine test results, outcome of systemic investigation, and long-term follow-up in children with anisocoria. Methods. Retrospective review of medical records and phone interview of consecutive pediatric patients (<18 years old) who underwent cocaine testing from August 2007 to July 2015 at a tertiary referral centre. Results. A total of 35 patients were included with a positive, negative, or inconclusive cocaine test in 12/35, 19/35, and 4/35, respectively. Systemic investigation was performed in 11 of the patients with a positive and in 2 of the patients with an inconclusive cocaine test result. Mediastinal Hodgkin lymphoma was found in one patient with an inconclusive cocaine test result. Two other cases were presumably related to birth trauma and surgical trauma. None of the other children further developed any pathology during the follow-up period of 34.8 months (range 0–106.6). Conclusions. In most children with anisocoria and a positive cocaine test result, systemic investigation did not reveal any underlying etiology. The only malignant disease was diagnosed in a patient with a suspicion of Horner’s syndrome but with an inconclusive cocaine test result in our cohort.

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Attitudes and Perceptions About Disclosing HIV and Syphilis Results Using Smarttest, a Smartphone App Dedicated to Self- and Partner Testing

AIDS Education and Prevention ◽

10.1521/aeap.2021.33.3.234 ◽

2021 ◽

Vol 33 (3) ◽

pp. 234-248

Author(s):

Bryan A. Kutner ◽

Anthony T. Pho ◽

Javier López-Rios ◽

Cody Lentz ◽

Curtis Dolezal ◽

...

Keyword(s):

Partner Notification ◽

Linkage To Care ◽

Sexual Partners ◽

Smartphone App ◽

Test Results ◽

Negative Results ◽

Partner Testing ◽

Attitudes And Perceptions ◽

Positive Results ◽

Test Result

We explored interest in disclosing test results through a smartphone app dedicated to self- and partner testing for HIV/syphilis. Fifty-nine cisgender men and transgender women each participated in an in-person survey and interview. We examined their interests in sharing test results by audience (e.g., partners, physicians) and by positive versus negative test result. Participants wanted the ability to share results, with notable interest in disclosing negative results to sexual partners and on social media and forwarding positive results to physicians. Participants envisioned smartphone sharing as a means to normalize testing, to notify partners of results, and to expedite linkage to care. Some questioned the authenticity of results shared by smartphone, while others voiced optimism that a personalized, authenticated app could ensure the security and veracity of results. Smartphone testing apps for HIV/syphilis may facilitate disclosure, partner notification, and linkage to care, but need to address concerns about the security and veracity of results.

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The Issue of Recurrently Positive Patients Who Recovered From COVID-19 According to the Current Discharge Criteria: Investigation of Patients from Multiple Medical Institutions in Wuhan, China

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa301 ◽

2020 ◽

Vol 222 (11) ◽

pp. 1784-1788 ◽

Cited By ~ 8

Author(s):

You Zou ◽

Bin-Ru Wang ◽

Liu Sun ◽

Shan Xu ◽

Yong-Gang Kong ◽

...

Keyword(s):

Test Results ◽

Rt Pcr ◽

Chain Reaction ◽

Current Discharge ◽

Negative Results ◽

Medical Institutions ◽

Polymerase Chain ◽

Discharge Criteria ◽

Test Result ◽

Pcr Test

Abstract The current discharge criteria for COVID-19 require that patients have 2 consecutive negative results for reverse transcription polymerase chain reaction (RT-PCR) detection. Here, we observed that recurrent positive RT-PCR test results in patients with 3 consecutive negative results (5.4%) were significantly decreased compared with those in patients with 2 consecutive negative results (20.6%); such patients reported positive RT-PCR test results within 1 to 12 days after meeting the discharge criteria. These results confirmed that many recovered patients could show a positive RT-PCR test result, and most of these patients could be identified by an additional RT-PCR test prior to discharge.

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Item Context and /s/ Phone Articulation Test Results

Journal of Speech and Hearing Research ◽

10.1044/jshr.1504.852 ◽

1972 ◽

Vol 15 (4) ◽

pp. 852-860 ◽

Cited By ~ 8

Author(s):

Zoe Zehel ◽

Ralph L. Shelton ◽

William B. Arndt ◽

Virginia Wright ◽

Mary Elbert

Keyword(s):

Test Score ◽

Sound Production ◽

Broad Context ◽

Test Results ◽

Production Task ◽

Test Result

Fourteen children who misarticulated some phones of the /s/ phoneme were tape recorded articulating several lists of items involving /s/. The lists included the Mc-Donald Deep Test for /s/, three lists similar to McDonald’s but altered in broad context, and an /s/ sound production task. Scores from lists were correlated, compared for differences in means, or both. Item sets determined by immediate context were also compared for differences between means. All lists were found to be significantly correlated. The comparison of means indicated that both broad and immediate context were related to test result. The estimated “omega square” statistic was used to evaluate the percentage of test score variance attributable to context.

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A Case of COVID-19-Related Thrombocytopenia and Leukopenia in an Adolescent with Mild Symptoms

Children ◽

10.3390/children8060509 ◽

2021 ◽

Vol 8 (6) ◽

pp. 509

Author(s):

Lydia Kossiva ◽

Athanasios Thirios ◽

Eleni Panagouli ◽

Alexandros Panos ◽

Stavroula Lampidi ◽

...

Keyword(s):

Bone Marrow ◽

Viral Infection ◽

Nasal Congestion ◽

Pediatric Population ◽

Clinical Manifestations ◽

Bone Marrow Aspiration ◽

White Blood Count ◽

Chronic Obstructive ◽

First Case ◽

The Impact

Since the beginning of the COVID-19 pandemic, there have been numerous reports and reviews on the complications caused by the disease, analyzing the acute and chronic consequences. The main symptoms of SARS-CoV-2 are dry cough, fever, and fatigue. COVID-19 appears to affect all systems, including renal, cardiovascular, circulatory, and respiratory systems, causing chronic obstructive pulmonary disease. We report on a 14-year-old male adolescent, who presented with thrombocytopenia (platelet count 92 × 109 /L) and leukopenia (white blood count 4.2 × 103 /μL) that was observed two months ago. Ten days before the first blood test, a viral infection with nasal congestion and runny nose was reported, without other accompanying symptoms. Viral antibodies screening revealed positivity for all the three specific COVID-19 antibodies. Further haematological evaluation with bone marrow aspiration revealed non-specific dysplastic features of the red cell and megakaryocyte progenitors. Although haematological alterations due to COVID-19 infection are available from adult patients’ reports, the effect of COVID-19 infection in the pediatric population is underestimated and this is the first case with such haematological involvement. Noteworthy, in the current case, the impact of the COVID-19 infection was not related to the severity of the disease, as the symptoms were mild. In similar cases, bone marrow aspiration would not be performed as a part of routine work-up. Thus, it is important when evaluating pediatric patients with COVID-19 infection to search and report those alterations in order to better understand the impact and the spectrum of clinical manifestations of the specific viral infection in children and adolescents.

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Using Indicator Bacteria and Salmonella Test Results from Three Large-Scale Beef Abattoirs over an 18-Month Period To Evaluate Intervention System Efficacy and Plan Carcass Testing for Salmonella

Journal of Food Protection ◽

10.4315/0362-028x-70.12.2732 ◽

2007 ◽

Vol 70 (12) ◽

pp. 2732-2740 ◽

Cited By ~ 21

Author(s):

JOHN R. RUBY ◽

JUN ZHU ◽

STEVEN C. INGHAM

Keyword(s):

Lactic Acid ◽

Large Scale ◽

Microbial Contamination ◽

Test Results ◽

Microbiological Contamination ◽

Negative Results ◽

Intervention Process ◽

Beef Carcasses ◽

Causative Factors ◽

Plate Counts

To develop a process for predicting the likelihood of Salmonella contamination on beef carcasses, we evaluated the influence of several possible causative factors (i.e., year, abattoir, day of week, month, and intervention system components) on the risk of Salmonella and indicator organism contamination. Hide and carcass sponge samples were collected in 2005 to 2006 in six steps at three abattoirs in the East (A), Midwest (B), and Southwest (C) United States. Each abattoir used the same intervention system. Samples were analyzed for aerobic plate counts (APCs; n = 18,990) and Enterobacteriaceae counts (EBCs; n = 18,989) and the presence or absence of Salmonella (n = 5,355). Our results demonstrated that many factors play a significant role in the level of microbial contamination of beef carcasses. Overall, Salmonella prevalence and EBC levels were significantly higher in 2006 than in 2005. APCs and EBCs were highest in abattoirs A (3.57 log CFU/100 cm2) and B (1.31 log CFU/100 cm2). The odds of detecting a positive Salmonella isolate were greatest in abattoir C and lowest in abattoir A. Across the three abattoirs, the overall intervention process effectively reduced microbiological contamination. Salmonella prevalence fell from 45% (preevisceration) to 0.47% (postchilled–lactic acid), and there were APC and EBC reductions of 5.43 and 5.28 log CFU/100 cm2, respectively, from hide-on to postchilled–lactic acid samples. At each abattoir, composites of three individual EBC-negative carcass samples yielded Salmonella-negative results 97 to 99% of the time. These results suggest the possibility of using indicator test results to accurately predict the absence of Salmonella in a beef carcass sample.

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Influenza colloidal gold method and blood routine tests combination for rapid diagnosis of influenza: a decision tree-based analysis

npj Primary Care Respiratory Medicine ◽

10.1038/s41533-021-00251-x ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Xiaoguang Li ◽

Jing Chen ◽

Fei Lin ◽

Wei Wang ◽

Jie Xu ◽

...

Keyword(s):

Decision Tree ◽

Predictive Value ◽

Colloidal Gold ◽

Influenza A ◽

Clinical Manifestations ◽

Rapid Test ◽

Test Results ◽

Tree Model ◽

Routine Blood ◽

Test Result

AbstractRapid influenza diagnosis can facilitate targeted treatment and reduce antibiotic misuse. However, diagnosis efficacy remains unclear. This study examined the efficacy of a colloidal gold rapid test for rapid influenza diagnosis. Clinical characteristics of 520 patients with influenza-like illness presenting at a fever outpatient clinic during two influenza seasons (2017–2018; 2018–2019) were evaluated. The clinical manifestations and results of routine blood, colloidal gold, and nucleic acid tests were used to construct a decision tree with three layers, nine nodes, and five terminal nodes. The combined positive predictive value of a positive colloidal gold test result and monocyte level within 10.95–12.55% was 88.2%. The combined negative predictive value of a negative colloidal gold test result and white blood cell count > 9.075 × 109/L was 84.9%. The decision-tree model showed the satisfactory accuracy of an early influenza diagnosis based on colloidal gold and routine blood test results.

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Rare Diseases, Common Problems: Recognition and Management

PEDIATRICS ◽

10.1542/peds.62.6.1056 ◽

1978 ◽

Vol 62 (6) ◽

pp. 1056-1060

Author(s):

Neil A. Holtzman

Keyword(s):

Johns Hopkins Hospital ◽

Full Time ◽

Test Results ◽

Irreversible Damage ◽

Negative Results ◽

Initial Symptoms ◽

Metabolic Conditions ◽

Common Problems

Although a growing number of inherited metaboic diseases can be treated effectively, diagnosis often comes too late to benefit the patient. There are at least two ways, however, in which diagnosis can be made before irreversible damage occurs. First, physicians whose services are sought when a patient becomes ill could be attuned to the possibility of metabolic conditions. This is difficult when the initial symptoms, for example, vomiting or poor feeding, resemble those of common, self-limited illnesses, or when they suggest, as with respiratory distress, other categories of serious illness. Second, all infants could be screened for indicators of some of these conditions. Then the primary physician has a responsibility to determine the significance of both positive and negative results and to decide whether follow-up is needed. This study had three objectives: (1) to determine whether physicians are aware of the common problems with which inherited metabolic conditions often present; (2) to determine whether their management of common problems facilitates the early diagnosis of such conditions; and (3) to assess their evaluation of screening test results. METHODS Physicians who were participating in three continuing education programs were asked to answer, anonymously, several questions dealing with recognition and in management of geneticmetaboic diseases before they were given any instruction on the subject. The same questionnaire was distributed to the pediatric house staff at The Johns Hopkins Hospital. The tabulated results were discussed with the respondents collectively during hour-long conferences. RESULTS AND COMMENTS Classification of Respondents One hundred fifty-six physicians returned the questionnaire: 67 pediatricians (in practice, 56; full-time faculty, 6: unknown, 5), 30 general or family practitioners, and 59 pediatric house officers.

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Patient recommendations for content and design for electronic return of genetic test results: An interview study among patients who accessed their genetic test results online (Preprint)

10.2196/preprints.29706 ◽

2021 ◽

Author(s):

Diane M Korngiebel ◽

Kathleen McGlone West

Keyword(s):

Patient Preferences ◽

Genetic Test ◽

Smartphone Application ◽

Patient Portal ◽

Genetic Test Result ◽

Test Results ◽

User Centered Design ◽

Detailed Report ◽

Genetic Test Results ◽

Test Result

BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following User-Centered Design methods, 59 interviews were conducted using semi-structured protocols. The interviews explored content and design issues for patient portal results return for patients who received electronic results for specific types of genetic tests (pharmacogenomic, hereditary blood disorders, and positive and negative risk results for heritable cancers) or who had electronically received any type of genetic test result as well as a non-genetic test result. RESULTS In general, a majority of participants felt that there always needed to be some clinician involvement in electronic results return and that electronic coversheets with simple summaries would be helpful for facilitating that. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for those results summaries, such as only reporting the information that was most important for patients to understand, including next steps, and to do so using clear language free of medical jargon. Electronic results return should also include explicit encouragement for patients to contact providers with questions. Finally, many participants preferred to manage their care using their smartphones, particularly in instances where they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results, therefore, health systems and patient portal software vendors should accommodate smartphone application design and web portal design concomitantly when developing results return platforms. CLINICALTRIAL N/A

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