Ethyl alcohol threshold test: a fast, reliable and affordable olfactory Assessment tool for COVID-19 patients
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RHINOLOGY
Ethyl alcohol threshold test: a fast, reliable and affordable olfactory Assessment tool for COVID‑19 patients Christian Calvo‑Henriquez1,2 · Byron Maldonado‑Alvarado1,2 · Carlos Chiesa‑Estomba1,3 · Irene Rivero‑Fernández1,4 · Marta Sanz‑Rodriguez4 · Ithzel María Villarreal5 · Miguel Rodriguez‑Iglesias6 · Franklin Mariño‑Sánchez7 · Alejandro Rivero‑de‑Aguilar8 · Jerome R. Lechien1,9 · Gabriel Martínez‑Capoccioni1,2 · Sven Saussez10 · Robson Capasso11 · Petros D. Karkos1,12 · Valentin Schriever13 · Carlos Martin‑Martin2 · Isam Alobid14 · Alfonso Santamaría‑Gadea7 · Claudio Fragola7 · Miguel Mayo‑Yáñez1,15 · Hugo Pérez‑Freixo16 · Elisabeth Ninchritz‑Becerra3 · María Soriano‑Reixach3 · Elisabeth Mondragon‑Rezola17 · Maria del Mar Martínez Ruiz‑Coello5 · Raimundo Andrés Navarro5 · Alfredo García‑Fernández4 · Álvaro Marchan‑López4 Received: 11 May 2020 / Accepted: 12 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective COVID-19 patients may present mild symptoms. The identification of paucisymptomatic patients is paramount in order to interrupt the transmission chain of the virus. Olfactory loss could be one of those early symptoms which might help in the diagnosis of COVID-19 patients. In this study, we aim to develop and validate a fast, inexpensive, reliable and easy-to-perform olfactory test for the screening of suspected COVID-19 patients. Study design Phase I was a case–control study and Phase II a transversal descriptive study. Subjects and methods Olfaction was assessed with the ethyl alcohol threshold test and symptoms with visual analogue scales. The study was designed in two phases: In Phase I, we compared confirmed COVID-19 patients and healthy controls. In Phase II, patients with suspected COVID-19 infection referred for testing were studied. Results 275 participants were included in Phase I, 135 in Phase II. The ROC curve showed an AUC of 0.749 in Phase I, 0.737 in Phase II. The cutoff value which offered the highest amount of correctly classified patients was ≥ 2 (10% alcohol) for all age intervals. The odds ratio was 8.19 in Phase I, 6.56 in Phase II with a 75% sensitivity. When cases report normal sense of smell (VAS 3–7) and severe (VAS > 7–10) diseases [9]. Using this criterion, we stratified patients according to VAS smell loss: normosmic-mild olfactory loss (VAS 0–3), moderate olfactory loss (VAS 4–6) and severe olfactory loss (VAS 7–10).
Sample selection
Alcohol threshold test (ATT)
The sample was recruited from five tertiary referral hospitals in Spain (Hospital Complex of Santiago de Compostela; Hospital 12 de Octubre; Donostia University Hospital; Hospital Ramon y Cajal and Fuenlabrada Hospital). Patients were recruited in two phases:
We propose a modification of Davidson’s alcohol sniff test [8]. In this study, Ethyl alcohol was diluted in saline solutions with five different concentrations (10%, 25%, 50%, 70% and 96%). It was prepared by the researchers using 100 ml saline bags following the dilutions includ
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