| Id |
Subject |
Object |
Predicate |
Lexical cue |
| T553 |
0-38 |
Sentence |
denotes |
Strengths and weaknesses of the review |
| T554 |
39-244 |
Sentence |
denotes |
Strengths of our review are the systematic and broad search performed to include all possible studies, including those prior to peer‐review, to gather the largest number of studies available at this point. |
| T555 |
245-536 |
Sentence |
denotes |
Exclusion of cases‐only studies, the largest number of the published cohorts of patients with COVID‐19, limits the available data but also improves the quality of the evidence and the possibility to present both sensitivity and specificity (cases only cannot provide both accuracy measures). |
| T556 |
537-682 |
Sentence |
denotes |
Because this is a living systematic review, future updates may offer the possibility to do a meta‐analysis, which was not possible at this stage. |
| T557 |
683-854 |
Sentence |
denotes |
In addition, further insights into this novel disease may lead to new evidence on signs and symptoms that are more diagnostic, which we will incorporate in future updates. |
| T558 |
855-939 |
Sentence |
denotes |
The lack of data on combinations of signs and symptoms is an important evidence gap. |
| T559 |
940-1083 |
Sentence |
denotes |
Consequently, there is no evidence on syndromic presentation and the value of composite signs and symptoms on the diagnostic accuracy measures. |
| T560 |
1084-1187 |
Sentence |
denotes |
In addition, subgroup analyses by the pre‐defined variables were not feasible due to lack of reporting. |
| T561 |
1188-1288 |
Sentence |
denotes |
We need to assess multiple variables for their possible confounding effect on the summary estimates. |
| T562 |
1289-1536 |
Sentence |
denotes |
Possible confounders include the presence of other respiratory pathogens (seasonality), the phase of the epidemic, exposure to high versus low prevalence setting, high or low exposure risk, comorbidity of the participants, or time since infection. |
| T563 |
1537-1788 |
Sentence |
denotes |
Seasonality may influence specificity, because alternative diagnoses such as influenza or other respiratory viruses are more prevalent in winter, leading to more non‐COVID‐19 patients displaying symptoms such as cough or fever, decreasing specificity. |
| T564 |
1789-1918 |
Sentence |
denotes |
In this version of the review, all studies were conducted in Winter or early Spring, suggesting this may still have been at play. |
| T565 |
1919-2198 |
Sentence |
denotes |
However, social distancing policies have shortened this year's influenza season in several countries (www.who.int/influenza/surveillance_monitoring/updates/en/), which may have led to higher specificity for signs and symptoms than what we may expect in the next influenza season. |
| T566 |
2199-2282 |
Sentence |
denotes |
In future updates of the review, we will explore seasonality effects if data allow. |
| T567 |
2283-2464 |
Sentence |
denotes |
As for time since onset, given that the moment of infection is more likely than not an unrecognisable and unmeasurable variable, time since onset of symptoms can be used as a proxy. |
| T568 |
2465-2700 |
Sentence |
denotes |
Reporting of studies, with presentation of the 2x2 table stratified by time since onset of disease, is informative and might have the potential to increase accuracy of the signs and symptoms and their diagnostic differential potential. |
