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. 2025 May 2;25(1):352.
doi: 10.1186/s12887-025-05693-7.

Diagnostic accuracy of visual triage checklist in early recognition of COVID-19 cases in the pediatric population: A retrospective cohort study

Ayesha Imtiaz  1 , Abdullah Y Akkam  2 , Lulwah H AlThumali  3 , Ahlam M AlHarthi  4 , Honey G Porte  2 , Wesal S AlOsaimi  5 , Maha M A AlAsmari  6 , Rawda B G Salih  2 , Biswadev Mitra  7   8
Affiliations

Diagnostic accuracy of visual triage checklist in early recognition of COVID-19 cases in the pediatric population: A retrospective cohort study

Ayesha Imtiaz et al. BMC Pediatr. .

Abstract

Background: During the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities developed surveillance systems to identify patients suspected of having COVID-19 to segregate them during their hospital stay. As a part of this infection control strategy, the Ministry of Health in the Kingdom of Saudi Arabia developed a visual triage (VT) checklist for early screening and isolation of patients in the hospital. The aim of this study was to evaluate the diagnostic accuracy of this visual triage checklist in identifying children with COVID-19.

Methods: This was a retrospective, single center study that included all children who were tested for COVID-19 and were admitted to the hospital through the pediatric emergency department. The diagnostic accuracy of the visual triage checklist was assessed using COVID-19 PCR as the gold standard.

Results: A total of 1333 patients were included. The visual triage checklist had a sensitivity of 94.3% (95% CI: 87.2-98.1) and a specificity of 16.0% (95% CI: 14-18) with an area under the receiver operating characteristic curve of 0.55 (0.53-0.58). The positive predictive value of the checklist was low at 7.35% (95% CI: 5.9-9.0).

Conclusion: The VT checklist has high sensitivity, and is therefore potentially useful as an initial screening tool. However, the diagnosis of COVID-19 requires early secondary confirmation to avoid the large number of false positive cases associated with this tool.

Keywords: COVID-19 screening; Diagnostic accuracy; Infection control strategy; Pediatric; Visual triage checklist.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was reviewed and approved by the institutional review board (IRB) of KSMC (project number: H1RI-19-Aug21-01). The study was a retrospective chart review, and the need for obtaining consent was waived by the IRB. Official permission was requested to gain access to the data, with the privacy and confidentiality of the data and study results secured by restricting unauthorized access. This study was carried out in compliance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Visual Triage Checklist used for COVID-19 screening as a part of traffic control bundling, to cohort patients into those requiring isolation or non-isolation areas
Fig. 2
Fig. 2
STARD diagram of included participants
Fig. 3
Fig. 3
Area Under the Receiver Operating Characteristic curves of the Visual Triage Checklist to predict COVID-19, sub-grouped by age groups
See this image and copyright information in PMC

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