Challenges in the virtual assessment of COVID-19 infections in the community

Warren J. McIsaac; Ross Upshur; Sahana Kukan

doi:10.46747/cfp.6701e6

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RE: Challenges in the virtual assessment of COVID-19 infections in the community(1)
Tung Siu, Bobbi Bennett and Kaitlyn Ramsay

Published on: 02 February 2021

Published on: (2 February 2021)

RE: Challenges in the virtual assessment of COVID-19 infections in the community(1)
Tung Siu, Family Physician, Island Health
Other Contributors:
Bobbi Bennett, Emergency Registered Nurse

Kaitlyn Ramsay, Ph.D. candidate
Virtual assessments have limitations, but the indiscriminately use of in-person exam and imaging risk over-utilizing resources that are already critically limited during the pandemic. We urgently need research in identifying mild cases of COVID-19 in community contexts and how to manage low-risk patients presented with dyspnea over virtual assessment.

The Roth score was suggested as a potential tool to assist in the virtual evaluation of patients with dyspnea(2). There has been significant controversy surrounding the Roth Score. It was the topic of multiple expert reviews (3,4,5). In essence, the Roth Score is not validated and should not be used in isolation or at all.

While it is essential for clinicians not to be swayed by an un-validated tool, we are disheartened that there has not been additional research into the Roth Score. We are only aware of one study that further investigated the correlation between Roth Score and SpO2(6). Further research needs to be conducted on clinical assessment tools of this kind if any validated methods of virtual evaluation are to be established.

We are currently undertaking a research study - Assessing Dyspnea using Virtual Care during COVID Pandemic (ADViC2) that aims to investigate further any correlation between the Roth Score, SpO2 and other patient-oriented outcomes (e.g. hospital admission, additional clinical visit). Additional information is available at http://advicstudy.ca...
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Virtual assessments have limitations, but the indiscriminately use of in-person exam and imaging risk over-utilizing resources that are already critically limited during the pandemic. We urgently need research in identifying mild cases of COVID-19 in community contexts and how to manage low-risk patients presented with dyspnea over virtual assessment.

The Roth score was suggested as a potential tool to assist in the virtual evaluation of patients with dyspnea(2). There has been significant controversy surrounding the Roth Score. It was the topic of multiple expert reviews (3,4,5). In essence, the Roth Score is not validated and should not be used in isolation or at all.

While it is essential for clinicians not to be swayed by an un-validated tool, we are disheartened that there has not been additional research into the Roth Score. We are only aware of one study that further investigated the correlation between Roth Score and SpO2(6). Further research needs to be conducted on clinical assessment tools of this kind if any validated methods of virtual evaluation are to be established.

We are currently undertaking a research study - Assessing Dyspnea using Virtual Care during COVID Pandemic (ADViC2) that aims to investigate further any correlation between the Roth Score, SpO2 and other patient-oriented outcomes (e.g. hospital admission, additional clinical visit). Additional information is available at http://advicstudy.ca

References:
(1) McIsaa et al. Challenges in the virtual assessment of COVID-19 infections in the community. Canadian Family Physician January 2021, 67 (1) e6-e8
(2) Chorin et al. "Assessment of Respiratory Distress by the Roth Score." Clinical cardiology 39, no. 11 (2016): 636-639.
(3) Baxter, Cantarutti and Catterall. “Primary Care in the Time of COVID-19: Three Family Physicians Share Their Experiences. '' Webinars UBC CPD. https://ubccpd.ca/primary-care-time-covid-19-three-family-physicians-sha... (accessed 2 Feb 2021)
(4) Allen and McCormack. “Clinical Question: Are there any techniques (like the Roth Score) to augment a typical history when assessing dyspnea/pneumonia over the phone or by video?” Tools for Practice https://gomainpro.ca/wp-content/uploads/tools-for-practice/1588106260_tf... (accessed 2 Feb 2021)
(5)Alberta Health Services. "COVID-19 Scientific Advisory Group Rapid Response Report" https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-s... 20 Apr 2020. (accessed 2 Feb 2021)
(6) Wilcock, Grafton-Clarke and Coulson. “What is the value of community oximetry monitoring in people with SARS-CoV-2?” https://www.medrxiv.org/content/10.1101/2021.01.03.21249168v1 (accessed 26 Jan 2021).
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Competing Interests: Dr. Tung Siu and Ms. Bobbi Bennett are investigators for the Assessing Dyspnea using Virtual Care during COVID Pandemic (ADViC2) research project. Ms. Kaitlyn Ramsay is a Research Coordinator for the ADViC2 research project.