Tests
Your Organizational Guidance
ebpracticenet urges you to prioritize the following organizational guidance:
Opvolging en revalidatie van patiënten met aanhoudende klachten na COVID-19 in de eerste lijnPublished by: KU Leuven | Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2023Suivi et revalidation des patients présentant des symptômes persistants après la COVID-19 en première lignePublished by: KU Leuven | Groupe de Travail Développement de recommmandations de première ligneLast published: 20231st tests to order
clinical diagnosis
Test
Long COVID is primarily a clinical diagnosis based on the history and physical exam. Any tests requested should be selective and tailored to the patient's symptoms.[1]
Result
varied presentations of long-term symptoms
complete blood count
comprehensive metabolic panel
creatine kinase
C-reactive protein
erythrocyte sedimentation rate
serum ferritin level
thyroid function tests
serum 25-hydroxy vitamin D
pulse oximetry
Test
Perform as part of initial evaluation for all patients presenting with long COVID to evaluate for hypoxia with exertion, which would be concerning for intrinsic lung pathology. Ambulatory pulse oximetry via a 6-minute walk test should be completed for patients with dyspnea, exertional intolerance, or persistent fatigue.[83]
Result
normal
Tests to consider
orthostatic testing-tilt table testing
Test
For patients presenting with activity intolerance, fatigue, cognitive impairment, generalized malaise, dyspnea, dizziness, and/or palpitations, obtain a 10-minute orthostatic stand test with measurement of heart rate and blood pressure at 5 minutes after laying supine and 1, 2, 5, and 10 minutes after standing. If in-office orthostatic testing is inconclusive, obtain formal tilt-table testing.[87]
Result
normal
electrocardiogram
pulmonary function testing
chest radiograph
chest CT
B-type natriuretic peptide
D-dimer
antinuclear antibody
rheumatoid factor
anti-cyclic citrulinated peptide
serum vitamin B12
blood thiamine
serum folate
plasma homocysteine
high sensitivity troponin
transthoracic echocardiogram
ambulatory cardiac monitoring
Test
Request in patients with persistent cardiopulmonary symptoms following COVID-19 or symptoms of dysautonomia (dizziness, lightheadedness, palpitations).[81]
Result
normal
cardiac stress test
Test
Request in patients with persistent chest pain or dyspnea on exertion that is concerning for cardiovascular disease.[81]
Result
normal
cardiopulmonary exercise test
Test
Request in patients with unclear etiology of ongoing symptoms and difficulty differentiating cause of ongoing symptoms (cardiac, pulmonary, or peripheral metabolic).[81]
Result
normal
cardiac MRI
Test
Request in patients with abnormalities on ECG, echocardiogram, or ambulatory cardiac monitoring, or if persistent symptoms are concerning for myocarditis.[81]
Result
normal
autonomic function testing
Test
Autonomic function testing should be obtained for patients who have continued severe symptoms concerning for autonomic dysfunction despite normal orthostatic screening. Testing includes deep breathing testing, Valsalva maneuver testing, quantitative sudomotor axon reflex testing, thermoregulatory sweat testing, and a skin biopsy.[87]
Result
normal
overnight sleep study
Test
Consider ordering in patients with persistent fatigue with signs or symptoms concerning for sleep apnea.[82]
Result
normal
MRI head
Test
Consider ordering if the patient has physical exam findings concerning for focal neurologic deficit or central etiology.[94]
Result
normal
neuropsychological testing
Test
Consider ordering in patients with significant persistent cognitive or mood issues.[39]
Result
normal
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