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Med."],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The study aimed to evaluate the diagnostic accuracy of contact history and clinical symptoms and to develop decision rules for ruling-in and ruling-out SARS-CoV-2 infection in family practice. We performed a prospective diagnostic study. Consecutive inclusion of patients coming for COVID-PCR testing to 19 general practices. Contact history and self-reported symptoms served as index test. PCR testing of nasopharyngeal swabs served as reference standard. Complete data were available from 1141 patients, 605 (53.0%) female, average age 42.2 years, 182 (16.0%) COVID-PCR positive. Multivariable logistic regression showed highest odds ratios (ORs) for \u201ccontact with infected person\u201d (OR 9.22, 95% CI 5.61\u201315.41), anosmia\/ageusia (8.79, 4.89\u201315.95), fever (4.25, 2.56\u20137.09), and \u201csudden disease onset\u201d (2.52, 1.55\u20134.14). Patients with \u201ccontact with infected person\u201d or \u201canosmia\/ageusia\u201d with or without self-reported \u201cfever\u201d had a high probability of COVID infection up to 84.8%. Negative response to the four items \u201ccontact with infected person, anosmia\/ageusia, fever, sudden disease onset\u201d showed a negative predictive value (NPV) of 0.98 (95% CI 0.96\u20130.99). This was present in 446 (39.1%) patients. NPV of \u201ccompletely asymptomatic,\u201d \u201cno contact,\u201d \u201cno risk area\u201d was 1.0 (0.96\u20131.0). This was present in 84 (7.4%) patients. To conclude, the combination of four key items allowed exclusion of SARS-CoV-2 infection with high certainty. With the goal of 100% exclusion of SARS-CoV-2 infection to prevent the spread of SARS-CoV-2 to the population level, COVID-PCR testing could be saved only for patients with negative response in all items. The decision rule might also help for ruling-in SARS-CoV-2 infection in terms of rapid assessment of infection risk.<\/jats:p>","DOI":"10.1038\/s41533-021-00258-4","type":"journal-article","created":{"date-parts":[[2021,11,25]],"date-time":"2021-11-25T11:08:02Z","timestamp":1637838482000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["COVID-19 assessment in family practice\u2014A clinical decision rule based on self-rated symptoms and contact history"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2847-8626","authenticated-orcid":false,"given":"Antonius","family":"Schneider","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Rauscher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0670-6392","authenticated-orcid":false,"given":"Christina","family":"Kellerer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Linde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederike","family":"Kneissl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Hapfelmeier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,25]]},"reference":[{"key":"258_CR1","doi-asserted-by":"publisher","first-page":"2153","DOI":"10.1001\/jama.2020.21694","volume":"324","author":"YC Manabe","year":"2020","unstructured":"Manabe, Y. 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