Nigerian Postgraduate Medical Journal

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 29  |  Issue : 2  |  Page : 96--101

Assessment of the utility of a screening tool for COVID-19 diagnosis in an accident and emergency department in Lagos, Nigeria: A pilot study


Erereoghor Otrofanowei1, Iorhen Ephraim Akase1, Bolaji Oluwarotimi Olopade2, Patricia E Akintan3, Uyiekpen E Ima-Edomwonyi2, Yeside Olubunmi Akinbolagbe3, Osigwe Paul Agabi1, Danladi Abraham Nmadu2, Gbemileke O Akinbode4, Adefolarin Opawoye2, C Aramide Olasope2, Adewale Ogundare2, B Abiola Bolarinwa5, Oluwakemi Elizabeth Awojumobi-Otokiti5, Precious J Enajeroh2, Moses Karami2, Christopher Imokhuede Esezobor3, Gbenga Olorunfemi6, Yewande O Oshodi6, Ayotunde Ayodeji Oluwole7, Wasiu Lanre Adeyemo8, Christopher O Bode9 
1 Department of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
2 Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
3 Department of Pediatrics, College of Medicine, University of Lagos, Idi-Araba, Nigeria
4 Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
5 Department of Hematology and Blood Transfusion, Lagos University Teaching Hospital, Lagos, Nigeria
6 Division of Epidemiology and Biostatistics, University of Witwatersrand, Johannesburg, South Africa
7 Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
8 Department of Oral and Maxillofacial Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
9 Department of Surgery, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria

Correspondence Address:
Iorhen Ephraim Akase
Department of Medicine, Infectious Disease Unit, College of Medicine, University of Lagos, Idi.Araba, Lagos
Nigeria

The use of reverse transcription–polymerase chain reaction (RT-PCR) is the gold standard laboratory test for diagnosing SARS-CoV-2 infection. However, it has the disadvantage of a long turnaround time and cost. The Nigeria Centre for Disease Control (NCDC) formulated a case definition for COVID-19. We sought to determine the utility of a 14-item, point-weighted clinical screening questionnaire adapted from the NCDC case definition in identifying patients more likely to have the disease. This was to aid prompt clinical decision-making. Methods: We retrospectively reviewed the data of 113 non-surgical patients presenting to the Accident and Emergency Department (A and E) of Lagos University Teaching Hospital, Lagos, Nigeria. Patients were stratified based on screening scores into low (0–2), moderate (3–5) and high (6) pre-test categories. Patients with low and high scores ≥6 were admitted to the A and E and the COVID-19 holding ward, respectively, while the moderate group had chest computed tomography scans to aid further decision-making, pending the outcome of their RT-PCR results. The validity of the triage score as compared to the RT-PCR test result was calculated and the kappa score of agreement was utilised to evaluate the concordance between two triage scores. The optimum cut-off score was also obtained based on the maximal Younden's index. Results: The frequencies of low, moderate and high pre-test scores were 34 (30%), 43 (38.1%) and 36 (31.9%), respectively. Overall, 38.1% (43/113) were RT-PCR positive. RT-PCR was positive in 26.5% (9/34) with low screening scores, 55.8% (24/43) with moderate scores and 27.8% (10/36) with high scores. The sensitivity and specificity of a high score of 6 were 25% and 92.86%, while the lower score of 3 had sensitivity and specificity of 62.5% and 58.6%, respectively. Conclusion: The screening tool showed a high specificity in its initial design, which suggests that anyone with a low score using this tool has a high probability of testing negative. We recommend a cut-off score of 4 (score A) or 6 (score B) of the current screening tool be used to increase the chances of identifying persons with COVID-19 for RT-PCR testing.


How to cite this article:
Otrofanowei E, Akase IE, Olopade BO, Akintan PE, Ima-Edomwonyi UE, Akinbolagbe YO, Agabi OP, Nmadu DA, Akinbode GO, Opawoye A, Olasope C A, Ogundare A, Bolarinwa B A, Awojumobi-Otokiti OE, Enajeroh PJ, Karami M, Esezobor CI, Olorunfemi G, Oshodi YO, Oluwole AA, Adeyemo WL, Bode CO. Assessment of the utility of a screening tool for COVID-19 diagnosis in an accident and emergency department in Lagos, Nigeria: A pilot study.Niger Postgrad Med J 2022;29:96-101


How to cite this URL:
Otrofanowei E, Akase IE, Olopade BO, Akintan PE, Ima-Edomwonyi UE, Akinbolagbe YO, Agabi OP, Nmadu DA, Akinbode GO, Opawoye A, Olasope C A, Ogundare A, Bolarinwa B A, Awojumobi-Otokiti OE, Enajeroh PJ, Karami M, Esezobor CI, Olorunfemi G, Oshodi YO, Oluwole AA, Adeyemo WL, Bode CO. Assessment of the utility of a screening tool for COVID-19 diagnosis in an accident and emergency department in Lagos, Nigeria: A pilot study. Niger Postgrad Med J [serial online] 2022 [cited 2022 Jul 1 ];29:96-101
Available from: https://www.npmj.org/article.asp?issn=1117-1936;year=2022;volume=29;issue=2;spage=96;epage=101;aulast=Otrofanowei;type=0