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Boldt KL, Bolanaki M, Holert F, Fischer-Rosinský A, Slagman A, Möckel M. Effects of Different SARS-CoV-2 Testing Strategies in the Emergency Department on Length of Stay and Clinical Outcomes: A Randomised Controlled Trial. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:9571236. [PMID: 38384429 PMCID: PMC10881249 DOI: 10.1155/2024/9571236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/19/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
The turn-around-time (TAT) of diagnostic and screening measures such as testing for SARS-CoV-2 can affect a patient's length of stay (LOS) in the hospital as well as the emergency department (ED). This, in turn, can affect clinical outcomes. Therefore, a reliable and time-efficient SARS-CoV-2 testing strategy is necessary, especially in the ED. In this randomised controlled trial, n = 598 ED patients presenting to one of three university hospital EDs in Berlin, Germany, and needing hospitalisation were randomly assigned to two intervention groups and one control group. Accordingly, different SARS-CoV-2 testing strategies were implemented: rapid antigen and point-of-care (POC) reverse transcription polymerase chain reaction (rtPCR) testing with the Roche cobas® Liat® (LIAT) (group one n = 198), POC rtPCR testing with the LIAT (group two n = 197), and central laboratory rtPCR testing (group three, control group n = 203). The median LOS in the hospital as an inpatient across the groups was 7 days. Patients' LOS in the ED of more than seven hours did not differ significantly, and furthermore, no significant differences were observed regarding clinical outcomes such as intensive care unit stay or death. The rapid and POC test strategies had a significantly (p < 0.01) shorter median TAT (group one 00:48 h, group two 00:21 h) than the regular central laboratory rtPCR test (group three 06:26 h). However, fast SARS-CoV-2 testing strategies did not reduce ED or inpatient LOS significantly in less urgent ED admissions. Testing strategies should be adjusted to the current circumstances including crowding, SARS-CoV-2 incidences, and patient cohort. This trial is registered with DRKS00023117.
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Affiliation(s)
| | | | | | | | - Anna Slagman
- Charité-Universitätsmedizin Berlin, Berlin, Germany
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May L, Robbins EM, Canchola JA, Chugh K, Tran NK. A study to assess the impact of the cobas point-of-care RT-PCR assay (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at Davis Medical Center. J Clin Virol 2023; 168:105597. [PMID: 37742483 DOI: 10.1016/j.jcv.2023.105597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2023] [Accepted: 09/17/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Rapid detection of SARS-CoV-2 is crucial for reduction of transmission and clinical decision-making. Several rapid (<30 min) molecular point-of-care (POC) tests based on nucleic acid amplification exist for diagnosis of SARS-CoV-2 & Influenza A/B infections. METHODS This unblinded, pre-post study enrolled consecutive patients with symptoms/signs consistent with SARS-CoV-2 infection presenting to the University of California, Davis emergency department (ED). Outcomes following implementation of the cobas® SARS-CoV-2 & Influenza A/B test for use on the cobas Liat System (intervention: December 2020-May 2021) were compared with previous standard-of-care using centralized laboratory reverse transcriptase polymerase chain reaction (RT-PCR) methods (control: April 2020-October 2020). RESULTS Electronic health records of 8879 symptomatic patient visits were analyzed, comprising 4339 and 4540 visits and 538 and 638 positive SARS-CoV-2 PCR test results in the control and intervention periods, respectively. Compared with the control period, turnaround time (TAT) was shorter in the intervention period (median 0.98 vs 12.30 h; p < 0.0001). ED length of stay (LOS) was generally longer in the intervention period compared with the control period, but for those SARS-CoV-2-negative who were admitted, ED LOS was shorter (median 12.53 vs 17.93 h; p < 0.0001). The rate of antibiotic prescribing was lower in the intervention than in the control period (42.86% vs 49.16%; p < 0.0001) and antiviral prescribing was higher (7.64% vs 5.49%; p < 0.0001). CONCLUSION This real-world study confirms faster TAT with a POC RT-PCR method in an emergency care setting and highlights the importance of rapid SARS-CoV-2 detection to aid patient management and inform treatment decisions.
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Affiliation(s)
- Larissa May
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, California, USA
| | | | | | - Kamal Chugh
- Roche Molecular Systems, Pleasanton, California, USA
| | - Nam K Tran
- Department of Emergency Medicine, University of California, Davis, Sacramento, California, USA.
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Donnelly JA, Russell M, O'Brien G, O'Neill I, Fitzpatrick F, O'Connell K. Preparing for the next pandemic: lessons learnt from the implementation of point-of-care SARS-CoV-2 testing in an emergency department. J Clin Pathol 2023; 76:642-646. [PMID: 37193583 DOI: 10.1136/jcp-2023-208857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
Point-of-care testing (POCT) provides rapid, accurate results that facilitate diagnosis and patient management. POCT for infectious agents allows timely infection prevention and control interventions and informs decisions around safe patient placement. However, POCT implementation requires careful governance as they are primarily operated by staff with limited prior education on laboratory quality control and assurance processes. Here, we describe our experience implementing SARS-CoV-2 POCT in the emergency department of a large tertiary referral hospital during the COVID-19 pandemic. We describe collaborative governance between pathology and clinical specialities, quality assurance, testing (volume and positivity rates), impact on patient flow and focus on lessons learnt during implementation that should be incorporated into revised pandemic preparedness planning.
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Affiliation(s)
| | | | - Gemma O'Brien
- Near Patient Testing, Beaumont Hospital, Dublin, Ireland
| | - Ian O'Neill
- Information and Communications Technologies Department, Beaumont Hospital, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Microbiology, Beaumont Hospital, Dublin, Ireland
- Microbiology, RCSI, Dublin, Ireland
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Achenbach CJ, Caputo M, Hawkins C, Balmert LC, Qi C, Odorisio J, Dembele E, Jackson A, Abbas H, Frediani JK, Levy JM, Rebolledo PA, Kempker RR, Esper AM, Lam WA, Martin GS, Murphy RL. Clinical evaluation of the Diagnostic Analyzer for Selective Hybridization (DASH): A point-of-care PCR test for rapid detection of SARS-CoV-2 infection. PLoS One 2022; 17:e0270060. [PMID: 35709204 PMCID: PMC9202852 DOI: 10.1371/journal.pone.0270060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND An ideal test for COVID-19 would combine the sensitivity of laboratory-based PCR with the speed and ease of use of point-of-care (POC) or home-based rapid antigen testing. We evaluated clinical performance of the Diagnostic Analyzer for Selective Hybridization (DASH) SARS-CoV-2 POC rapid PCR test. METHODS We conducted a cross-sectional study of adults with and without symptoms of COVID-19 at four clinical sites where we collected two bilateral anterior nasal swabs and information on COVID-19 symptoms, vaccination, and exposure. One swab was tested with the DASH SARS-CoV-2 POC PCR and the second in a central laboratory using Cepheid Xpert Xpress SARS-CoV-2 PCR. We assessed test concordance and calculated sensitivity, specificity, negative and positive predictive values using Xpert as the "gold standard". RESULTS We enrolled 315 and analyzed 313 participants with median age 42 years; 65% were female, 62% symptomatic, 75% had received ≥2 doses of mRNA COVID-19 vaccine, and 16% currently SARS-CoV-2 positive. There were concordant results for 307 tests indicating an overall agreement for DASH of 0.98 [95% CI 0.96, 0.99] compared to Xpert. DASH performed at 0.96 [95% CI 0.86, 1.00] sensitivity and 0.98 [95% CI 0.96, 1.00] specificity, with a positive predictive value of 0.85 [95% CI 0.73, 0.96] and negative predictive value of 0.996 [95% CI 0.99, 1.00]. The six discordant tests between DASH and Xpert all had high Ct values (>30) on the respective positive assay. DASH and Xpert Ct values were highly correlated (R = 0.89 [95% CI 0.81, 0.94]). CONCLUSIONS DASH POC SARS-CoV-2 PCR was accurate, easy to use, and provided fast results (approximately 15 minutes) in real-life clinical settings with an overall performance similar to an EUA-approved laboratory-based PCR.
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Affiliation(s)
- Chad J. Achenbach
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
| | - Matthew Caputo
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
| | - Claudia Hawkins
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
| | - Lauren C. Balmert
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
| | - Chao Qi
- Department of Pathology, Northwestern University, Evanston, IL, United States of America
| | - Joseph Odorisio
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
| | - Etienne Dembele
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
| | - Alema Jackson
- Access Community Health Network, Chicago, IL, United States of America
| | - Hiba Abbas
- Access Community Health Network, Chicago, IL, United States of America
| | - Jennifer K. Frediani
- Atlanta Center for Microsystems Engineered Point-of-Care Technologies, Atlanta, GA, United States of America
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States of America
| | - Joshua M. Levy
- Atlanta Center for Microsystems Engineered Point-of-Care Technologies, Atlanta, GA, United States of America
- Emory University Department of Otolaryngology, Atlanta, GA, United States of America
| | - Paulina A. Rebolledo
- Atlanta Center for Microsystems Engineered Point-of-Care Technologies, Atlanta, GA, United States of America
- Emory University Division of Infectious Diseases, Atlanta, GA, United States of America
| | - Russell R. Kempker
- Atlanta Center for Microsystems Engineered Point-of-Care Technologies, Atlanta, GA, United States of America
- Emory University Division of Infectious Diseases, Atlanta, GA, United States of America
| | - Annette M. Esper
- Atlanta Center for Microsystems Engineered Point-of-Care Technologies, Atlanta, GA, United States of America
- Emory University Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA, United States of America
| | - Wilbur A. Lam
- Atlanta Center for Microsystems Engineered Point-of-Care Technologies, Atlanta, GA, United States of America
- Emory University Department of Pediatrics, Atlanta, GA, United States of America
| | - Greg S. Martin
- Atlanta Center for Microsystems Engineered Point-of-Care Technologies, Atlanta, GA, United States of America
- Emory University Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA, United States of America
| | - Robert L. Murphy
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
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