• Nick K Jones, Isobel Ramsay, Elinor Moore, Jonathan Fuld, Chris Adcock, Edward Banham-Hall, Judith Babar, Effrossyni Gkrania-Klotsas, and Hoi Ping Mok.
• Addenbrooke's Hospital, Cambridge, UK nicholas.jones@addenbrookes.nhs.uk.
• Clin Med (Lond). 2021 Mar 1; 21 (2): e140e143e140-e143.

IntroductionWithout universal access to point-of-care SARS-CoV-2 testing, many hospitals rely on clinical judgement alone for identifying cases of COVID-19 early.MethodsCambridge University Hospitals NHS Foundation Trust introduced a 'traffic light' clinical judgement aid to the COVID-19 admissions unit in mid-March 2020. Ability to accurately predict COVID-19 was audited retrospectively across different stages of the epidemic.ResultsOne SARS-CoV-2 PCR positive patient (1/41, 2%) was misallocated to a 'green' (non-COVID-19) area during the first period of observation, and no patients (0/32, 0%) were mislabelled 'green' during the second period. 33 of 62 (53%) labelled 'red' (high risk) tested SARS-CoV-2 PCR positive during the first period, while 5 of 22 (23%) 'red' patients were PCR positive in the second.ConclusionCOVID-19 clinical risk stratification on initial assessment effectively identifies non-COVID-19 patients. However, diagnosing COVID-19 is challenging and risk of overcalling COVID-19 should be recognised, especially when background prevalence is low.© Royal College of Physicians 2021. All rights reserved.

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