Frequency and Clinical Utility of Olfactory Dysfunction in COVID-19: a Systematic Review and Meta-analysis
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RHINOSINUSITIS (J MULLOL, SECTION EDITOR)
Frequency and Clinical Utility of Olfactory Dysfunction in COVID-19: a Systematic Review and Meta-analysis Khang Wen Pang 1 & Jeremy Chee 1 & Somasundaram Subramaniam 2 & Chew Lip Ng 2 Accepted: 8 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Olfactory dysfunction (OD) has been gaining recognition as a symptom of COVID-19, but its clinical utility has not been well defined. Objectives To quantify the clinical utility of identifying OD in the diagnosis of COVID-19 and determine an estimate of the frequency of OD amongst these patients. Methods PubMed was searched up to 1 August 2020. Meta-analysis A included studies if they compared the frequency of OD in COVID-19 positive patients (proven by reverse transcription polymerase chain reaction) to COVID-19 negative controls. Metaanalysis B included studies if they described the frequency of OD in COVID-19 positive patients and if OD symptoms were explicitly asked in questionnaires or interviews or if smell tests were performed. Results The pooled frequency of OD in COVID-19 positive patients (17,401 patients, 60 studies) was 0.56 (0.47–0.64) but differs between detection via smell testing (0.76 [0.51–0.91]) and survey/questionnaire report (0.53 [0.45–0.62]), although not reaching statistical significance (p = 0.089). Patients with reported OD were more likely to test positive for COVID-19 (diagnostic odds ratio 11.5 [8.01–16.5], sensitivity 0.48 (0.40 to 0.56), specificity 0.93 (0.90 to 0.96), positive likelihood ratio 6.10 (4.47–8.32) and negative likelihood ratio 0.58 (0.52–0.64)). There was significant heterogeneity amongst studies with possible publication bias. Conclusion Frequency of OD in COVID-19 differs greatly across studies. Nevertheless, patients with reported OD were significantly more likely to test positive for COVID-19. Patient-reported OD is a highly specific symptom of COVID-19 which should be included as part of the pre-test screening of suspect patients. Keywords Meta-analysis . Severe acute respiratory syndrome . Coronavirus 2 . Olfaction disorders . COVID-19
Key Points Question: What is the clinical utility of olfactory dysfunction (OD) in the diagnosis of COVID-19? Findings: In this meta-analysis, the pooled frequency of OD in COVID-19 positive patients (17401 patients, 60 studies) was 0.56 (0.47 to 0.64). Patients with reported OD were more likely to test positive for COVID19 with a diagnostic odds ratio 11.5 (8.01 to 16.5), sensitivity 0.48 (0.40 to 0.56), specificity 0.93 (0.90 to 0.96), positive likelihood ratio 6.05 (4.52 to 8.11) and negative likelihood ratio 0.60 (0.54 to 0.67). Meaning: Patient-reported OD is a highly specific symptom of COVID19 which should be included as part of the pre-test screening of suspect patients. This article is part of the Topical Collection on Rhinosinusitis * Khang Wen Pang [email protected]
1
Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore
2
Departm
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