PMC:7386785 / 83401-142108 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7386785","sourcedb":"PMC","sourceid":"7386785","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7386785","text":"Characteristics of included studies [ordered by study ID]\nAi 2020a\nStudy characteristics\nPatient Sampling Purpose: diagnosis of SARS‐CoV‐2 pneumoniaDesign: cross‐sectional multicentre prospective studyRecruitment: hospitalised pneumonia patientsSample size: n = 53 (20 cases)Inclusion criteria: suspected SARS‐COV‐2 pneumonia patients, defined as having pneumonia after chest CT (with 1 of the 2 following criteria met: fever or respiratory symptoms, normal or decreased WBC counts/decreasedExclusion criteria: not defined\nPatient characteristics and setting Facility cases: confirmed case: a positive SARS‐COV‐2 nucleotides result either by metagenomic sequencing or RT‐PCR assay for nasopharyngeal swab specimensFacility controls: pneumonia patients confirmed not to be infected by SARS‐Cov2 (2 PCR tests, 2 days in between)Country: ChinaDates: 22 January 2020‐19 February 2020Symptoms and severity: suspected SARS‐COV‐2 pneumonia (NCP): having pneumonia after chest CT with 1 of the 2 following criteria met: fever or respiratory symptoms, normal or decreased WBC counts/decreased lymphocyte counts, and a travel history or contact with patients with fever or respiratory symptoms from Hubei Province or confirmed cases within 2 weeksDemographics: median age cases 37 years, controls 39 years, gender distribution cases (M/F: 50/50), controls (M/F: 48.5/51.5)Exposure history: not specified\nIndex tests Fever\nDry cough\nDiarrhoea\nFatigue\nHeadache\nVomiting\nAbdominal pain\nTarget condition and reference standard(s) TC: COVID‐19 pneumonia\nRS: a positive SARS‐COV‐2 nucleotides result either by metagenomic sequencing or RT‐PCR assay for nasopharyngeal swab specimens, repeated after 2 days if negative on day 0\nFlow and timing Time interval not specified. Reference standard at day 0 and day 2, index tests from electronic medical records but stated at pneumonia onset\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Unclear    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? No    \nCould the selection of patients have introduced bias?   High risk  \nAre there concerns that the included patients and setting do not match the review question?     High\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Unclear    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nChen X 2020\nStudy characteristics\nPatient Sampling Purpose: diagnosis COVID‐19 pneumonia ‐ to identify differences in CT imaging and clinical manifestations between pneumonia patients with and without COVID‐19, and to develop and validate a diagnostic model for COVID‐19 based on radiological semantic and clinical featuresDesign: cross‐sectional multicentre retrospective studyRecruitment:\u2028cases: consecutive patients with COVID‐19 admitted in 5 independent hospitals\u2028controls: at the same period, another 66 consecutive pneumonia patients without COVID‐19 from Meizhou People’s HospitalSample size: n = 136 (cases = 70)Inclusion criteria: patients admitted with COVID‐19 pneumonia (cases) and patients admitted with non‐COVID‐19 pneumonia (controls)Exclusion criteria: not specified for cases except those from 1 hospital (Meizhou), for cases and controls in Meizhou: after chest CT neoplasm, tuberculosis, pulmonary oedema, pulmonary contusion, aspiration pneumonia, bronchitis, any local or systemic treatment before CT scan, normal CT image without epidemiological history\nPatient characteristics and setting Facility cases: pneumonia patients with positive SARS‐CoV‐2 testFacility controls: CT pneumonia patients with consecutive negative RT‐PCRCountry: ChinaDates: 1 January 2020‐8 February 2020Symptoms and severity: pneumonia patients for cases and control; unclear severity of casesDemographics: M/F: cases 41/29, controls 43/23\u2028mean age: cases 42.9 range, 16‐69 years, controls 46.7 range, 0.3‐93 yearsExposure history: data about exposure to epidemic centres collected, but no results in the study nor in appendices\nIndex tests Systolic BP\nDiastolic BP\nRespiration rate\nHeart rate\nTemperature\nDry cough\nFatigue\nSore throat\nStuffy\nRunny nose\nTarget condition and reference standard(s) TC: COVID‐19 pneumonia\nRS: RT‐PCR and next generation sequencing for SARS‐Cov2\nFlow and timing Time interval not specified\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Yes    \nDid the study avoid inappropriate inclusions? No    \nCould the selection of patients have introduced bias?   High risk  \nAre there concerns that the included patients and setting do not match the review question?     High\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Unclear    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   Unclear risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Unclear\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Yes    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nCheng 2020a\nStudy characteristics\nPatient Sampling Purpose: to identify the clinical features and CT manifestations of COVID‐19 and compare them with those of pneumonia occurring in patients who do not have COVID‐19Design: cross‐sectional single‐centre retrospective studyRecruitment: pneumonia patients who presented at a fever observation department in ShanghaiSample size: n = 33 (11 cases)Inclusion criteria: patients with clinical and radiological features of pneumonia, and a normal or reduced total leukocyte count or total lymphocyte count, plus an epidemiologic history that included travel or a history of residence in Hubei province or other areas where continuous transmission of local cases occurred within 14 days before onset of symptoms, a history of contact with patients who had fever or respiratory symptoms and were from Hubei province or other areas with continuous transmission of local cases within 14 days before onset of the disease, or clustering or epidemiologic association with the new coronavirus infectionExclusion criteria: not defined\nPatient characteristics and setting Facility cases: confirmed case: positive RT‐PCR test result obtained by a throat swab. Test was repeated when the first test was negativeFacility controls: pneumonia patients confirmed not to be infected by SARS‐Cov2 (2 PCR tests)Country: ChinaDates: 19 January 2020‐6 February 2020Symptoms and severity: pneumonia was defined as patients with at least 1 clinical symptom (i.e. cough, sputum, fever, dyspnoea, or pleuritic chest pain), a finding of either coarse crackles on auscultation or elevated inflammatory biomarkers, and observation of a new pulmonary opacification on chest CTDemographics: median age +‐ SD cases 50.36 +‐ 15.5, controls 43.59 +‐ 16.02, gender distribution cases (M/F: 8/3), controls (M/F: 7/15)Exposure history: cases 8/11, controls 7/22 (in the last 14 days with patients with fever or respiratory symptoms or with known cases)\nIndex tests Fever\nCough\nSputum\nShortness of breath\nMuscle ache\nDiarrhoea\nSore throat\nPeak body temperature\nTarget condition and reference standard(s) TC: COVID‐19 pneumonia\nRS: RT‐PCR testing on throat swab specimens\nTests were repeated if the first test was negative\nFlow and timing Time interval not specified, reference test at day 0 (or later when the first test was negative), index tests were questionnaired at day 0 for the presence of symptoms in the past period of time\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Unclear    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? No    \nCould the selection of patients have introduced bias?   High risk  \nAre there concerns that the included patients and setting do not match the review question?     High\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nFeng 2020a\nStudy characteristics\nPatient Sampling Purpose: diagnosis COVID‐19 pneumoniaDesign: cross‐sectional, retrospective, single‐centre studyRecruitment: patients admitted to ED with history of exposure to COVID‐19Sample size: n = 132 (cases = 7)inclusion criteria: all patients admitted to the fever clinic of the ED of the First medical center, Chinese People's Liberation Army General Hospital (PLAGH) in Beijing with the epidemiological history of exposure to COVID‐19 according to WHO interim guidanceExclusion criteria: \u003c 14 years old, no other criteria specified\nPatient characteristics and setting Facility cases: among clinically suspected patients: those with a positive RT‐PCRFacility controls: clinically non‐suspected patients + suspected patients with negative RT‐PCRCountry: ChinaDates: 14 January 2020‐9 February 2020Symptoms and severity: all patients admitted, with exposure history to COVID‐19, so all levels of severity; days from illness onset until admission (median, IQR): 2.0 (1.0‐5.0); patient population with general mild disease and limited presence of comorbidities (range 0%‐2.3% (COPD))Demographics: age: controls median 40.0 years (IQR 32.5‐54.5), cases median 39.0 years (IQR 37.0‐41.5)M%/F%: cases 71.4/28.6, controls 63.2/36.8Exposure history: epidemiological history of exposure to COVID‐19 (as per WHO guidance)\nIndex tests Heart rate\nDiastolic BP\nSystolic BP\nFever (former: median only on all and cases ‐ no control median given)\nHighest temperature\nCough\nShortness of breath\nMuscle ache\nHeadache\nSore throat\nRhinorrhoea\nDiarrhoea\nNausea\nVomiting\nChills\nShiver\nExpectoration\nAbdominal pain\nFatigue\nPalpitation\nTarget condition and reference standard(s) TC: COVID‐19 pneumonia\nRS: in‐house RT‐PCR (E‐gene) ‐ at 4 institutions\nFlow and timing Index test and RS both taken on admission\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Yes    \nDid the study avoid inappropriate inclusions? Yes    \nCould the selection of patients have introduced bias?   Low risk  \nAre there concerns that the included patients and setting do not match the review question?     Low concern\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   High risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Yes    \nDid all patients receive the same reference standard? No    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   High risk  \nLiang 2020\nStudy characteristics\nPatient Sampling Purpose: to estimate the prevalence of COVID‐19 in pneumonias during this period and to find the unique features of COVID‐19 as compared to pneumonias caused by other agentsDesign: cross‐sectional, single‐centre, retrospective studyRecruitment: 342 cases of pneumonia were diagnosed in Fever Clinic in Peking University Third Hospital. From these patients, 88 were reviewed by panel discussion as possible or probable cases of COVID‐19, and received 2019‐nCoV detection by RT‐PCRSample size: n = 88 (21 cases)Inclusion criteria: patients visiting the Fever Clinic at Peking University Third Hospital. Based on epidemiological history, epidemiological evidence, fever and/or respiratory symptoms, chest radiological findings and WBC results, cases with possible or probable COVID‐19 were sent for panel discussion and then for 2019‐nCoV detection by RT‐PCRExclusion criteria: COVID‐19 unlikely by panel discussion; lack of CT scan or no signs of pneumonia on CT scan; paediatric patients\nPatient characteristics and setting Facility cases: 2019‐nCoV real‐time PCR testing, which was positive in 19 cases (confirmed cases). In another 2 patients, though PCR testing was negative, a clinical diagnosis was made according to\u2028epidemiological evidence, consistent clinical and CT findings (clinical cases)Facility controls: for the cases with negative viral detection, the diagnosis of COVID‐19 was excluded based on inconsistent epidemiological, clinical or radiological dataCountry: ChinaDates: 21 January 2020‐15 February 2020SymptomsFever with a mean body temperature of 37.8 C\nCough\nExpectoration\nFatigue\nHeadache\nDizziness\nShortness of breath\nMyalgia or arthralgia\nSore throat\nNasal symptoms and diarrhoea\nSeverity of COVID‐19Mild‐moderate: fever and/or respiratory symptoms with pneumonia in radiology examination, without signs of severe or very severe diseases\nSevere: presence of 1 of the following: respiratory rate ≥ 30 beat/min; SpO2 ≤ 93% at rest; PaO2/FiO2 ≤ 300 mmHg\nVery severe: presence of 1 of the following: severe respiratory failure requiring mechanical ventilation; shock; complicated with other organ failure and requiring ICU admission\nDemographics: COVID‐group only: median age was 42.0 years (25th‐75th percentile, 34.5‐66.0 years). Range 24‐85. Male/female: 11 (52.4%)/10 (47.6%)Exposure history: 19/21 (90.5%) had a clear epidemiological history of COVID‐19. 7 patients, from 5 family clusters, had close contact with their family members\nIndex tests Fever with a mean body temperature of 37.8 C\nCough\nExpectoration\nFatigue\nHeadache\nDizziness\nShortness of breath\nMyalgia or arthralgia\nSore throat\nNasal symptoms and diarrhoea\nTarget condition and reference standard(s) TC: COVID‐19 pneumonia\nRS: 2019‐nCoV real‐time PCR testing or clinical diagnosis was made according to epidemiological evidence, consistent clinical and CT findings\nFlow and timing Time interval not specified\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Unclear    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? No    \nDid the study avoid inappropriate inclusions? No    \nCould the selection of patients have introduced bias?   High risk  \nAre there concerns that the included patients and setting do not match the review question?     High\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? No    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   High risk  \nNobel 2020\nStudy characteristics\nPatient Sampling Purpose: assess GI symptoms in COVID‐19 and their association with short‐term outcomesDesign: diagnostic case‐control, retrospective studyRecruitment: adults who underwent nasopharyngeal swab testing for SARS‐CoV‐2 at outpatient settings: clinics or the ED, of New York‐Presbyterian‐Columbia or the medical centre's affiliates in New YorkSample size: 516 (278 cases)Inclusion criteria: adults ≥ 18 years of age who underwent nasopharyngeal swab testing for SARS‐CoV‐2. Indications for testing during this period were respiratory symptoms (cough, fever, shortness of breath) with intent to hospitalise or the same symptoms in essential personnel.Exclusion criteria: if insufficient data were available in the electronic medical record or if testing was performed during a pre‐existing inpatient admission\nPatient characteristics and setting Facility cases: SARS‐CoV‐2 PCR test result positive (1 test)Facility controls: SARS‐CoV‐2 PCR test result negativeCountry: USADates: 10 March 2020‐21 March 2020Symptoms and severity: respiratory symptoms (cough, fever, shortness of breath) with intent to hospitalise or in essential workersDemographics: median age: 51‐70 years (cases and controls), gender distribution: cases (M/F(%): 52/48), controls (M/F(%): 45/55)Exposure history: not specified\nIndex tests GI symptoms: diarrhoea, vomiting/nausea\nTarget condition and reference standard(s) TC: SARS‐Cov‐2 infection\nRS: SARS‐CoV‐2 PCR test, once (nasopharyngeal swab)\nFlow and timing Time interval: both taken at intake\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? No    \nDid the study avoid inappropriate exclusions? Yes    \nDid the study avoid inappropriate inclusions? Yes    \nCould the selection of patients have introduced bias?   Low risk  \nAre there concerns that the included patients and setting do not match the review question?     Low concern\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Yes    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nPeng 2020a\nStudy characteristics\nPatient Sampling Purpose: analyse the clinical features and imaging manifestations of COVID‐19Design: cross‐sectional, single‐centre, retrospective studyRecruitment: clinically suspected cases who were sent to hospital for screeningSample size: n = 86 (n = 11)Inclusion criteria: clinically suspected patientsExclusion criteria: not specified\nPatient characteristics and setting Facility cases: positive RT‐PCR via nasopharyngeal swabFacility controls: negative RT‐PCR via nasopharyngeal swab (1x)Country: ChinaDates: 23 January 2020‐16 February 2020Symptoms and severity: fever, cough, dyspnoea, sore throat, fatigue, systemic soreness, runny noseDemographics: M/F: total 39/47, cases: 5/6, controls 34/40Case group: mean age 40.73 ± 11.32 years, 5 men. Control group: mean age 39.67 ± 13.90 years, 34 menExposure history: 7/11 COVID‐19 patients (63.6%) had a history of travel to Hubei (5 Wuhan, 1 Huanggang, 1 Xiaogan), 2 patients had close contact with the COVID‐19 patients, and 2 taxi drivers\nIndex tests Fever\nCough\nDyspnoea\nSore throat\nFatigue\nSystemic soreness\nRunny nose\nTarget condition and reference standard(s) TC: SARS‐Cov‐2 infection\nRS: RT‐PCR (nasopharyngeal swab)\nFlow and timing Time interval not specified\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Unclear    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? Unclear    \nCould the selection of patients have introduced bias?   Unclear risk  \nAre there concerns that the included patients and setting do not match the review question?     Unclear\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nRentsch 2020\nStudy characteristics\nPatient Sampling Purpose: diagnosis SARS‐CoV‐2 test positivesDesign: cross‐sectional, retrospective studyRecruitment: electronic health record data from the national Veterans Affairs Healthcare System ‐ national Corporate Data Warehouse (USA)Sample size: 3789 (585 cases)Inclusion criteria: all patients in the Veterans Affairs cohort, born between 1945 and 1965 and active in care, tested for COVID‐19 between 8 February and 30 March 2020Exclusion criteria: patients for whom results were pending (n = 93) or inconclusive (n = 33) were excluded\nPatient characteristics and setting Facility cases: tested positive for SARS‐CoV‐2Facility controls: tested negative for SARS‐CoV‐2Country: USADates: 8 February 2020‐30 March 2020Symptoms and severity: all patients who were tested were includedDemographics: median age overall: 65.7 years (IQR 60.5‐70.7) (cases: 66.1 years, controls: 65.6 years);gender overall (M%/F%): 90.2/9.8, cases 95.4/4.6, controls 89.2/10.8Exposure history: not specified (all over USA)\nIndex tests Hypoxia (oxygen saturation ≤ 93%)\nBody temperature (3 categories)\nTarget condition and reference standard(s) TC: SARS‐CoV‐2 infection\nRS: no data on reference PCR test used, multiple different reference tests used with unknown test characteristics (samples: nasopharyngeal swabs)\nFlow and timing Time interval maximum 2 days\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Yes    \nDid the study avoid inappropriate inclusions? Unclear    \nCould the selection of patients have introduced bias?   Low risk  \nAre there concerns that the included patients and setting do not match the review question?     Unclear\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Unclear    \nIf a threshold was used, was it pre‐specified? Yes    \nCould the conduct or interpretation of the index test have introduced bias?   Unclear risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Unclear    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Unclear risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Yes    \nDid all patients receive the same reference standard? Unclear    \nWere all patients included in the analysis? No    \nCould the patient flow have introduced bias?   Low risk  \nSong 2020b\nStudy characteristics\nPatient Sampling Purpose: to develop a tool for early diagnosis of SARS‐CoV2‐infected patientsDesign: cross‐sectional, retrospective, single‐centre (2 time frame study: training ‐ validation data set)Recruitment: 1311 patients who presented to the First Affiliated Hospital, School of Medicine, Zhejiang University with at least 1 SARS‐CoV‐2 RT‐PCR testSample size: n = 304 (73 cases) (= subset of the study including training dataset only)n = 95 (18 cases) (= validation dataset)Inclusion criteriaAll RT‐PCR‐positive cases; 1311\nAll RT‐PCR‐negative patients who came to the First Affiliated Hospital, School of Medicine, Zhejiang University and performed with at least 1 SARS‐CoV‐2 nucleic acid detection for analysis RT‐PCR\nFirst 60% of negative outpatients sorted by 'Z‐A' based on Chinese first name from Qingchun District (training dataset), and then final 40% who presented (validation dataset)\nExclusion criteriaAsymptomatic patients without history of exposure but had strong willingness for detection\nPatients with \"important\" missing data\nPatient characteristics and setting Facility cases: positive SARS‐CoV‐2Facility controls: negative SARS‐CoV‐2Country: ChinaDates: 20 January 2020‐05 February 2020Symptoms and severity: in positives: non‐severe (n = 31), including mild or moderate patients to severe (n = 42) including severe or critical patientsMild: patients had no pneumonia on imaging (CT)\nModerate: patients with symptoms and imaging examination showing pneumonia\nSevere: patients meet any of the following:\nrespiratory rate ≥ 30/min\nresting pulse SpO2 ≤ 93%\nPaO2/FiO2 ≤ 300 mmHg (1 mmHg = 0.133 kPa)\nmultiple pulmonary lobes showing more than 50% progression of lesion in 24‐48 hours on imaging\nCritical: patients meet any of the following:\nrespiratory failure requiring mechanical ventilation\nshock\ncombination of other organ failure that requires admission to ICU\nDemographics: M/F: cases 46/27, controls 104/127\u2028median age: cases 53.0 years (43.5‐62.0) controls 34 years (29‐49)Exposure history: Wuhan‐related exposure and or close contact to confirmed COVID‐19 case: cases 40.7%, controls 57.5%\nIndex tests Fever\nCough\nExpectoration\nHeadache\nMyalgia or fatigue\nChill\nRhinobyon/rhinorrhoea\nPharyngalgia\nDyspnoea\nDiarrhoea\nNausea/vomiting\nTemperature (maximum)\nBody temperature\nSpO2\nRespiratory rate\nHeart rate\nMean arterial pressure\nTarget condition and reference standard(s) TC: SARS‐CoV‐2 infection\nRS: RT‐PCR for SARS‐CoV‐2 (test not specified: \"using emergency use authorization approved SARS‐CoV‐2 assays)\" (following WHO protocol, 2 target RT‐PCR (ORF1 and N)\nFlow and timing Within 3 h for RS, first in‐hospital stay for index tests\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? No    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? Yes    \nCould the selection of patients have introduced bias?   Unclear risk  \nAre there concerns that the included patients and setting do not match the review question?     Low concern\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Unclear    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Yes    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Yes    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nSun 2020a\nStudy characteristics\nPatient Sampling Purpose: algorithm development for estimating risk COVID‐19Design: cross‐sectional, retrospective studyRecruitment: patients presenting at the designated national outbreak screening centre and tertiary care hospital in Singapore for SARS‐CoV‐2 testing. Patients were either self‐referred, referred from primary care facilities, or were at‐risk cases identified by national contact tracing efforts (recruited n = 991)Sample size: n = 788 (n = 54)Inclusion criteria: patients presenting to the centre:self‐referred\nreferred from primary care facilities\nat‐risk cases identified by national contact tracing efforts\nExclusion criteria: PCR results not available at time of data collection ‐ no electronic medical records ‐ unavailable vital sign records\nPatient characteristics and setting Facility cases: positive SARS‐CoV2 RT‐PCR testFacility controls: all SARS‐CoV‐2 RT‐PCR results were negative (minimum 2 test negatives in high‐risk patients, minimum 1 test low‐risk patients)Country: SingaporeDates: 26 January 2020‐16 February 2020Symptoms and severity: 252 (33.2%) symptoms \u003e 5 days at presentation, 75 (9.5%) any comorbiditybody temperature\nheart rate\nrespiratory rate\nsystolic BP\ndiastolic BP\ncough\nsputum production\nshortness of breath\nrhinnorhoea or nasal congestion\nsore throat\nauscultation finding of pneumonia\nother respiratory symptoms\ngastrointestinal symptoms\nDemographics: median age 34 years (range 7 years‐98 years, IQR 27‐45) (cases median 42 years, range 16‐79; controls 34 years (range 7‐98); M/F: 48.3%/51.7% F (cases M: 88 (88.9%))Exposure history: contact with a known COVID‐19 case (20.1% (32/54 cases (59.3%)); 126/734 controls (17.2%), contact with travellers from China (22.1%, 15/54 cases (27.8%); 42/734 controls (5.7%)), recent travel history, and visit to hospital in China within 14 days prior to symptom onset (0.8%)\nIndex tests Body temperature\nHeart rate\nRespiratory rate\nSystolic BP\nDiastolic BP\nCough\nSputum production\nShortness of breath\nRhinnorhea or nasal congestion\nSore throat\nAuscultation finding of pneumonia\nOther respiratory symptoms\nGI symptoms\nTarget condition and reference standard(s) TC: SARS‐CoV‐2 infection\nRS: SARS‐CoV‐2 2 commercial assays 2‐target (1 assay: Orf1ab and N ‐ other unclear) RT‐PCR\nFlow and timing Time interval not specified\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? No    \nDid the study avoid inappropriate exclusions? Yes    \nDid the study avoid inappropriate inclusions? Yes    \nCould the selection of patients have introduced bias?   High risk  \nAre there concerns that the included patients and setting do not match the review question?     High\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? No    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nTolia 2020\nStudy characteristics\nPatient Sampling Purpose: diagnosis of acute SARS‐CoV‐2 infectionDesign: cross‐sectional, retrospective studyRecruitment: all patients presenting to 1 of 2 EDs, located at an urban teaching hospital, and academic quaternary medical centre, within the same healthcare system who had targeted testing based on clinician's decision during the initial 10 days of test availabilitySample size: n = 283 (29 cases)Inclusion criteria:patients presenting with symptoms related to COVID‐19 infection (fever and cough or shortness of breath)\ntravel within 14 days to countries with high rates of infection (at that time China, Iran, Italy, Japan, and South Korea) or\nrisk factors for infection complications (including age or comorbid conditions) or\nthe patient was a healthcare worker who could potentially expose others at risk and clinician made decision for testing\nExclusion criteria: not specified\nPatient characteristics and setting Facility cases: positive SARS‐CoV‐2 testFacility controls: negative SARS‐CoV‐2 test, visiting the same EDs and being testedCountry: USA (San Diego, CA)Dates: 10 March 2020‐19 March 2020Symptoms and severity:all patients presenting to ED who were eligible for targeted testing (= patients presenting with symptoms related to COVID‐19 infection (fever and cough or shortness of breath)\ntravel within 14 days to countries with high rates of infection (at that time China, Iran, Italy, Japan, and South Korea) or\nrisk factors for infection complications (including age or comorbid conditions) or\nthe patient was a healthcare worker who could potentially expose others at risk\ncomorbidities 101/235 (43.0%) (cases: 8/27 (29.6%), controls 93/208 (44.7%))\nDemographics: age (\u003c 18 years: 0.7%, 18‐64 years: 83.4%, \u003e 65 years: 15.9%); gender: cases M/F%: 55.2/44.8; controls M/F%: 52.8/47.2; all M/F%: 53.0/47.0Exposure history: recent travel (5.5%), 90.6% symptom‐based criteria for testing, no known exposure history based\nIndex tests Fever\nTarget condition and reference standard(s) TC: SARS‐CoV‐2 infection\nRS: Commercial RT‐PCR test ‐ ePLex SARS‐CoV‐2 test (nasopharyngeal swab)\nFlow and timing Probably no time interval between index test and RS, but not specified\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? Yes    \nCould the selection of patients have introduced bias?   Unclear risk  \nAre there concerns that the included patients and setting do not match the review question?     Low concern\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Unclear risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nWee 2020\nStudy characteristics\nPatient Sampling Purpose: to analyse OTDs as a diagnostic criterion for COVID‐19Design: cross‐sectional, prospective single‐centre studyRecruitment: all suspected cases presenting to the EDSample size: n = 870 (cases = 154)Inclusion criteria:presence of respiratory symptoms and suspicious epidemiological links or travel history or\nnew onset OTD\nExclusion criteria: not specified\nPatient characteristics and setting Facility cases: positive RT‐PCR for 2019‐nCovFacility controls: negative RT‐PCR for 2019‐nCovCountry: SingaporeDates: 26 March 2020‐10 April 2020Symptoms and severity: loss of sense of smell/tasteDemographics: not specifiedExposure history: close contact of a confirmed COVID‐19 case: cases 42/112, controls 37/679\nIndex tests Loss of sense of smell/taste\nTarget condition and reference standard(s) TC: SARS‐Cov‐2 infection\nRS: RT‐PCR (oropharyngeal swabs)\nFlow and timing Time interval: same day\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Unclear    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? Yes    \nCould the selection of patients have introduced bias?   Low risk  \nAre there concerns that the included patients and setting do not match the review question?     Low concern\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Yes    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Low risk  \nYan 2020a\nStudy characteristics\nPatient Sampling Purpose: to evaluate association of patient‐reported symptoms with a focus on sense of smell and taste and SARS‐CoV‐2 infectionDesign: internet survey of patients after presentation to a single‐centreRecruitment: email invitation with 1 phone call follow‐up to everyone who was tested for COVID‐19 between 3 March 2020 and 29 March 2020Sample size: n = 262 (cases: 59)Inclusion criteria:adult patients who presented to the institution and got tested for COVID‐19\nanalysis on responders to email survey (responses: cases 59/102, controls 203/1378)\nExclusion criteria:\nPatient characteristics and setting Facility cases: SARS‐CoV‐2‐positiveFacility controls: SARS‐CoV‐2‐negativeCountry: USA, San DiegoDates: 3 March 2020‐29 March 2020Symptoms and severity:larger representation of ambulatory patients (higher response rate to survey)\nseverity ‐ hospital admission: cases 4/59, controls 14/203\nDemographics: adults only, M/F: cases 29/29, controls 69/132Exposure history: not specified\nIndex tests Fatigue\nLoss of taste\nFever\nLoss of sense of smell\nCough\nHeadache\nMyalgia\nDyspnoea\nDiarrhoea\nNasal obstruction\nSore throat\nRhinorrhoea\nNausea\nTarget condition and reference standard(s) TC: SARS‐CoV‐2 infection\nRS: PCR for SARS‐CoV‐2 (sample not specified)\nFlow and timing PCR taken at presentation, not specified when the questionnaire was sent. Patients had to list their symptoms at presentation.\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? Unclear    \nCould the selection of patients have introduced bias?   Unclear risk  \nAre there concerns that the included patients and setting do not match the review question?     Unclear\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? No    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Unclear    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Yes    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Low risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Unclear risk  \nYang 2020d\nStudy characteristics\nPatient Sampling Purpose: to identify differences in CT imaging and clinical features between COVID‐19 and\u2028influenza pneumonia in the early stage, and to identify the most valuable features in the differential\u2028diagnosisDesign: diagnostic case‐control study, retrospective multicentre with historic control groupRecruitment: cases: confirmed SARS‐CoV‐2 patients; controls: influenza pneumonia patients (1 January 2015‐30 September 2019 from 2 hospitals)Sample size: n = 121 (cases = 73)Inclusion criteria: patients confirmed with SARS‐CoV‐2; controls: patients who had 9 respiratory pathogen IgM antibody tested from January 2015‐September 2019Exclusion criteria: cases: not specifiedcontrols:parainfluenza\nrespiratory syncytial virus\nadenovirus\nLegionella spp\nMycoplasma pneumoniae\nChlamydia pneumoniae\nCoxiella burnetii\naspiration pneumonia\nradiation pneumonia\npulmonary contusion\npulmonary oedema\nneoplasm\nNo CT date, no clinical date\nPatient characteristics and setting Facility cases: positive RT‐PCR for 2019‐nCovFacility controls: influenza pneumoniaCountry: ChinaDates: 1 January 2020‐15 February 2020Symptoms and severity: all patients in early stages of COVID‐19 or influenza pneumoniaDemographics: M/F: cases 41/32, controls 30/18\u2028mean age: cases 41.9, controls 40.4Exposure history: not specified\nIndex tests Body temperature\nCough\nFatigue\nSore throat\nStuffy and runny nose\nTarget condition and reference standard(s) TC: COVID‐19 pneumonia\nRS: RT‐PCR (sample not specified)\nFlow and timing Time interval unclear\nComparative  \nNotes Overlaps with Chen X 2020\nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? No    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? No    \nCould the selection of patients have introduced bias?   High risk  \nAre there concerns that the included patients and setting do not match the review question?     High\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Unclear    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   High risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     High\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Unclear risk  \nZhao 2020a\nStudy characteristics\nPatient Sampling Purpose: to compare and assess the clinical features of COVID‐19 pneumonia with features in non‐COVID‐19 pneumonia patientsDesign: diagnostic case control, retrospective studyRecruitment: patients with similar duration between symptom onset to admission were selected as controlsSample size: n = 34 (n = 15)Inclusion criteria: admitted pneumonia cases with a history of travel to Hubei or exposure to a PCR SARS‐CoV‐2‐confirmed‐positive patientExclusion criteria: not specified\nPatient characteristics and setting Facility cases: single sputum or throat swab test RT‐PCR‐positive pneumoniaFacility controls: for non‐COVID‐19 confirmation: 3 consecutive negative throat swabs or sputum sampling every other day during first 7 days of admissionCountry: China, AnhuiDates: 23 January 2020‐5 February 2020Symptoms and severity:fever\ncough\nsore throat\nheadache\nfatigue\ndiarrhoea\nchest tightness\nabnormal lung auscultation\nDemographics: mean age (cases/controls): 48 (IQR 27~56)/35 (IQR 27~46) in COVID‐19 and non‐COVID‐19 patients, respectively; F/M (cases/controls): 8 (42.11%)Exposure history: all patients had a history of exposure to confirmed cases of 2019‐nCoV or travel to Hubei before illness. Investigators interviewed each patient and their relatives, where necessary, to determine exposure or close contact histories during the 2 weeks before the illness onset\nIndex tests Fever\nCough\nSore throat\nHeadache\nFatigue\nDiarrhoea\nChest tightness\nAbnormal lung auscultation\nTarget condition and reference standard(s) TC: COVID‐19 pneumonia\nRS: real‐time RT‐PCR (unknown assay) (sample: throat swabs or/and sputa)\nFlow and timing Time interval not specified\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? No    \nWas a case‐control design avoided? No    \nDid the study avoid inappropriate exclusions? Unclear    \nDid the study avoid inappropriate inclusions? Yes    \nCould the selection of patients have introduced bias?   High risk  \nAre there concerns that the included patients and setting do not match the review question?     High\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Yes    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Unclear risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Unclear    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? Yes    \nCould the patient flow have introduced bias?   Unclear risk  \nZhu 2020b\nStudy characteristics\nPatient Sampling Purpose: description of initial clinical features in patients with suspected and confirmed SARS‐CoV‐2 infectionDesign: cross‐sectional, retrospective studyRecruitment: all patients with suspected COVID‐19 who presented to the ED of the First Affiliated Hospital of USTC and the Infectious Hospital of the First Affiliated Hospital of USTC for the first timeSample size: n = 116 (32 cases)Inclusion criteria:patients defined as suspected SARS‐CoV‐2 infection based on guidelines for the diagnosis and treatment of pneumonia caused by novel coronavirus infection (trial version III)\npresentation to, clinical observation and quarantine in our ED\nnucleic acid amplification test performed in the ED\nExclusion criteria: transfer from another hospital or previous visit to our hospital and previous diagnosis of COVID‐19\nPatient characteristics and setting Facility cases: positive nucleic acid amplification test on admission or 24 h laterFacility controls: SARs‐CoV‐2 PCR test negativeCountry: China, AnhuiDates: 24 January 2020‐20 February 2020Symptoms and severity: all suspected COVID‐19 patients included; days since onset of symptoms median 5 (IQR 2‐7)Demographics: median age: all: 40 years (IQR 27‐53), cases: 46 years (IQR 35‐52), controls: 35 years (IQR 27‐53); gender distribution M%/F%: all 46/54, cases 47/53, controls 46/54Exposure history: no specific exposure history common to all patients with suspected disease: 8 (25%) diagnosed patients had visited Wuhan in the previous 2 weeks and 12 (38%) had been exposed to patients with infection in the previous 2 weeks\nIndex tests Fever\nCough\nMyalgia or fatigue\nExperctoration\nChest stuffiness (congestion)\nHaemoptysis\nHeadache\nDiarrhoea\nTarget condition and reference standard(s) TC: SARS‐CoV‐2 infection\nRS: nucleic acid amplification test not further specified (twice in case negatives) (samples: swabs, origin not specified)\nFlow and timing Index tests and RS both taken on admission or after 24 h\nComparative  \nNotes  \nMethodological quality\nItem Authors' judgement Risk of bias Applicability concerns\nDOMAIN 1: Patient Selection\nWas a consecutive or random sample of patients enrolled? Yes    \nWas a case‐control design avoided? Yes    \nDid the study avoid inappropriate exclusions? Yes    \nDid the study avoid inappropriate inclusions? Yes    \nCould the selection of patients have introduced bias?   Low risk  \nAre there concerns that the included patients and setting do not match the review question?     Low concern\nDOMAIN 2: Index Test (All tests)\nWere the index test results interpreted without knowledge of the results of the reference standard? Yes    \nIf a threshold was used, was it pre‐specified? No    \nCould the conduct or interpretation of the index test have introduced bias?   High risk  \nAre there concerns that the index test, its conduct, or interpretation differ from the review question?     Low concern\nDOMAIN 3: Reference Standard\nIs the reference standards likely to correctly classify the target condition? Yes    \nWere the reference standard results interpreted without knowledge of the results of the index tests? Unclear    \nCould the reference standard, its conduct, or its interpretation have introduced bias?   Unclear risk  \nAre there concerns that the target condition as defined by the reference standard does not match the question?     Low concern\nDOMAIN 4: Flow and Timing\nWas there an appropriate interval between index test and reference standard? Yes    \nDid all patients receive the same reference standard? Yes    \nWere all patients included in the analysis? 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