{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T20:23:52Z","timestamp":1782505432382,"version":"3.54.5"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001998"],"award-info":[{"award-number":["UL1TR001998"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>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 (\u22645 correctly identified odors) than SARS-CoV-2 negative patients (56.1% vs. 19.3%, OR = 5.36, P&lt;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 \u22651 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\u20130.80). The ROC curve for symptom screening had lower discriminatory accuracy for SARS-CoV-2 infection (AUC = 0.55, 95% CI 0.49\u20130.61, P&lt;0.001) than the smell testing ROC curve.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Smell testing was superior to symptom screening for identifying SARS-CoV-2 infection in our study.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0266912","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T18:20:10Z","timestamp":1649787610000},"page":"e0266912","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Performance of formal smell testing and symptom screening for identifying SARS-CoV-2 infection"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7193-065X","authenticated-orcid":true,"given":"James W.","family":"Keck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Bush","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Razick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Setareh","family":"Mohammadie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Musalia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Hamm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"pone.0266912.ref001","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1038\/s41591-020-0869-5","article-title":"Temporal dynamics in viral shedding and transmissibility of COVID-19","volume":"26","author":"X He","year":"2020","journal-title":"Nat Med"},{"key":"pone.0266912.ref002","doi-asserted-by":"crossref","first-page":"2509","DOI":"10.1080\/22221751.2020.1837015","article-title":"A multi-family cluster of COVID-19 associated with asymptomatic and pre-symptomatic transmission in Jixi City, Heilongjiang, China, 2020","volume":"9","author":"H Zhang","year":"2020","journal-title":"Emerg Microbes Infect"},{"key":"pone.0266912.ref003","article-title":"The Proportion of SARS-CoV-2 Infections That Are Asymptomatic","author":"DP Oran","year":"2021","journal-title":"Ann Intern Med"},{"key":"pone.0266912.ref004","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1038\/s41591-020-0916-2","article-title":"Real-time tracking of self-reported symptoms to predict potential COVID-19","volume":"26","author":"C Menni","year":"2020","journal-title":"Nat Med"},{"key":"pone.0266912.ref005","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s11154-016-9364-1","article-title":"New chemosensory component in the U.S. National Health and Nutrition Examination Survey (NHANES): first-year results for measured olfactory dysfunction","volume":"17","author":"HJ Hoffman","year":"2016","journal-title":"Rev Endocr Metab Disord."},{"key":"pone.0266912.ref006","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1001\/jamaoto.2019.1728","article-title":"Clinical Diagnosis and Current Management Strategies for Olfactory Dysfunction: A Review.","volume":"145","author":"KL Whitcroft","year":"2019","journal-title":"JAMA Otolaryngol\u2014Head Neck Surg"},{"key":"pone.0266912.ref007","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1177\/1945892420946254","article-title":"The Prevalence of Olfactory Dysfunction in the General Population: A Systematic Review and Meta-analysis","volume":"35","author":"VM Desiato","year":"2020","journal-title":"Am J Rhinol Allergy"},{"key":"pone.0266912.ref008","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1002\/alr.22587","article-title":"Smell dysfunction: a biomarker for COVID-19","volume":"10","author":"ST Moein","year":"2020","journal-title":"Int Forum Allergy Rhinol"},{"key":"pone.0266912.ref009","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"W Guan","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0266912.ref010","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1111\/j.1553-2712.1996.tb03538.x","article-title":"Statistical Methodology: I. 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