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The primary objective of this scoping review is to synthesize current research of the diagnostic accuracy of history, physical examination, routine laboratory tests, real\u2010time reverse transcription\u2013polymerase chain reaction (rRT\u2010PCR), immunology tests, and computed tomography (CT) for the emergency department (ED) diagnosis of COVID\u201019. Secondary objectives included a synopsis of diagnostic biases likely with current COVID\u201019 research as well as corresponding implications of false\u2010negative and false\u2010positive results for clinicians and investigators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses\u2013Scoping Review (PRISMA\u2010ScR)\u2013adherent synthesis of COVID\u201019 diagnostic accuracy through May 5, 2020, was conducted. The search strategy was designed by a medical librarian and included studies indexed by PubMed and Embase since January 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,907 citations were screened for relevance. Patients without COVID\u201019 are rarely reported, so specificity and likelihood ratios were generally unavailable. Fever is the most common finding, while hyposmia and hypogeusia appear useful to rule in COVID\u201019. Cough is not consistently present. Lymphopenia is the mostly commonly reported laboratory abnormality and occurs in over 50% of COVID\u201019 patients. rRT\u2010PCR is currently considered the COVID\u201019 criterion standard for most diagnostic studies, but a single test sensitivity ranges from 60% to 78%. Multiple reasons for false\u2010negatives rRT\u2010PCR exist, including sample site tested and disease stage during which sample was obtained. CT may increase COVID\u201019 sensitivity in conjunction with rRT\u2010PCR, but guidelines for imaging patients most likely to benefit are emerging. IgM and IgG serology levels are undetectable in the first week of COVID\u201019, but sensitivity (range\u00a0= 82% to 100%) and specificity (range\u00a0= 87% to 100%) are promising. Whether detectable COVID\u201019 antibodies correspond to immunity remains unanswered. Current studies do not adhere to accepted diagnostic accuracy reporting standards and likely report significantly biased results if the same tests were to be applied to general ED populations with suspected COVID\u201019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>With the exception of fever and disorders of smell\/taste, history and physical examination findings are unhelpful to distinguish COVID\u201019 from other infectious conditions that mimic SARS\u2010CoV\u20102 like influenza. Routine laboratory tests are also nondiagnostic, although lymphopenia is a common finding and other abnormalities may predict severe disease. Although rRT\u2010PCR is the current criterion standard, more inclusive consensus\u2010based criteria will likely emerge because of the high false\u2010negative rate of PCR tests. The role of serology and CT in ED assessments remains undefined.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14048","type":"journal-article","created":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T07:02:21Z","timestamp":1592290941000},"page":"653-670","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Diagnosing COVID\u201019 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2603-7157","authenticated-orcid":false,"given":"Christopher R.","family":"Carpenter","sequence":"first","affiliation":[{"name":"From the Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip A.","family":"Mudd","sequence":"additional","affiliation":[{"name":"From the Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin P.","family":"West","sequence":"additional","affiliation":[{"name":"the Division of General Internal Medicine Department of Medicine Division of Biomedical Statistics and Informatics Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Wilber","sequence":"additional","affiliation":[{"name":"Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott T.","family":"Wilber","sequence":"additional","affiliation":[{"name":"and the Asante Rogue Regional Medical Center Medford OR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,7,26]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.20.23119"},{"key":"e_1_2_8_3_1","unstructured":"U.S. Food and Drug Administration.Emergency Use Authorization (EUA) information and list of all current EUAs Food and Drug Administration.2020. 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