Evaluation of visual triage for screening of Middle East respiratory syndrome coronavirus patients

Abstract

The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in September 2012 in Saudi Arabia had attracted the attention of the global health community. In 2017 the Saudi Ministry of Health released a visual triage system with scoring to alert healthcare workers in emergency departments (EDs) and haemodialysis units for the possibility of occurrence of MERS-CoV infection. We performed a retrospective analysis of this visual score to determine its sensitivity and specificity. The study included all cases from 2014 to 2017 in a MERS-CoV referral centre in Riyadh, Saudi Arabia. During the study period there were a total of 2435 suspected MERS cases. Of these, 1823 (75%) tested negative and the remaining 25% tested positive for MERS-CoV by PCR assay. The application of the visual triage score found a similar percentage of MERS-CoV and non-MERS-CoV patients, with each score from 0 to 11. The percentage of patients with a cutoff score of ≥4 was 75% in patients with MERS-CoV infection and 85% in patients without MERS-CoV infection (p 0.0001). The sensitivity and specificity of this cutoff score for MERS-CoV infection were 74.1% and 18.6%, respectively. The sensitivity and specificity of the scoring system were low, and further refinement of the score is needed for better prediction of MERS-CoV infection.

Keywords: Middle East respiratory syndrome coronavirus (MERS-CoV); Saudi Arabia; Scoring; Visual triage.

Fig. 1

Visual triage form showing two sections, one related to patient presenting symptoms and signs and one related to risk of exposure to MERS-CoV. CAD, coronary artery disease; DM, diabetes mellitus; MERS-CoV, Middle East respiratory syndrome coronavirus.

Fig. 2

Percentage of patients (y-axis) with specified score (x-axis) in those with (solid line) and without (dashed line) MERS-CoV infection. MERS-CoV, Middle East respiratory syndrome coronavirus.