Performance of formal smell testing and symptom screening for identifying SARS-CoV-2 infection.

BACKGROUND: Altered sense of smell is a commonly reported COVID-19 symptom. The performance of smell testing to identify SARS-CoV-2 infection status is unknown. We measured the ability of formal smell testing to identify SARS-CoV-2 infection and compared its performance with symptom screening. METHODS: A convenience sample of emergency department patients with COVID-19 symptom screening participated in smell testing using an eight odor Pocket Smell Test (PST). Participants received a SARS-CoV-2 viral PCR test after smell testing and completed a health conditions survey. Descriptive analysis and receiver operating characteristic (ROC) curve models compared the accuracy of smell testing versus symptom screening in identifying SARS-CoV-2 infection. RESULTS: Two hundred and ninety-five patients completed smell testing and 87 (29.5%) had a positive SARS-CoV-2 PCR test. Twenty-eight of the SARS-CoV-2 positive patients (32.2%) and 49 of the SARS-CoV-2 negative patients (23.6%) reported at least one of seven screening symptoms (OR = 1.54, P = 0.13). SARS-CoV-2 positive patients were more likely to have hyposmia (≤5 correctly identified odors) than SARS-CoV-2 negative patients (56.1% vs. 19.3%, OR = 5.36, P<0.001). Hyposmia was 52.9% (95% CI 41.9%-63.7%) sensitive and 82.7% (95% CI 76.9%-87.6%) specific for SARS-CoV-2 infection. Presence of ≥1 screening symptom was 32.2% (95% CI 22.6%-43.1%) sensitive and 76.4% (70.1%-82.0%) specific for SARS-CoV-2 infection. The ROC curve for smell testing had an area under the curve (AUC) of 0.74 (95% CI 0.67-0.80). The ROC curve for symptom screening had lower discriminatory accuracy for SARS-CoV-2 infection (AUC = 0.55, 95% CI 0.49-0.61, P<0.001) than the smell testing ROC curve. CONCLUSION: Smell testing was superior to symptom screening for identifying SARS-CoV-2 infection in our study.

Telemedicine in the emergency department in the era of COVID-19: front-line experiences from 2 institutions.

During the COVID-19 pandemic, one of the major changes that has occurred in emergency medicine is the evolution of telemedicine. With relaxation of regulatory and administrative barriers, the use of this already available technology has rapidly expanded. Telemedicine provides opportunity to markedly decrease personal protective equipment (PPE) and reduce healthcare worker exposures. Moreover, with the convenience and availability of access to medical care via telemedicine, a more fundamental change in healthcare delivery in the United States is likely. The implementation of telemedicine in the emergency department (ED) in particular has great potential to prevent the iatrogenic spread of COVID-19 and protect health care workers. Challenges to widespread adoption of telemedicine include privacy concerns, limitation of physical examination, and concerns of patient experience. In this clinical review, we discuss ED telemedicine applications, logistics, and challenges in the COVID-19 era as well as recent regulatory and legal changes. In addition, examples of telemedicine use are described from 2 institutions. Examples of future applications of telemedicine within the realm of emergency medicine are also discussed.