Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19

Summary: Background: Point-of-care (POC) SARS-CoV-2 lateral-flow antigen detection (LFD) testing in the emergency department (ED) could inform rapid infection control decisions but requirements for safe deployment have not been fully defined Methods: Review of LFD test results, laboratory and POC-R...

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Autores principales:	B. Merrick, M. Noronha, R. Batra, S. Douthwaite, G. Nebbia, L.B. Snell, S. Pickering, R.P. Galao, J. Whitfield, A. Jahangeer, R. Gunawardena, T. Godfrey, R. Laifa, K. Webber, P.R. Cliff, E. Cunningham, S.J.D. Neil, H. Gettings, J.D. Edgeworth, H.L. Harrison
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	SARS-CoV-2 Lateral flow viral antigen detection devices LFD Emergency department Nosocomial transmission Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/a045b9a13c7740cf86e2666a29fd91c2
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spelling	oai:doaj.org-article:a045b9a13c7740cf86e2666a29fd91c22021-12-04T04:35:46ZReal-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-192590-088910.1016/j.infpip.2021.100186https://doaj.org/article/a045b9a13c7740cf86e2666a29fd91c22021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2590088921000755https://doaj.org/toc/2590-0889Summary: Background: Point-of-care (POC) SARS-CoV-2 lateral-flow antigen detection (LFD) testing in the emergency department (ED) could inform rapid infection control decisions but requirements for safe deployment have not been fully defined Methods: Review of LFD test results, laboratory and POC-RT-PCR results and ED-performance metrics during a two-week high SARS-CoV-2 prevalence period followed by several months of falling prevalence. Aim: Determine whether LFD testing can be safely deployed in ED to provide an effective universal SARS-CoV-2 testing capability. Findings: 93% (345/371) of COVID-19 patients left ED with a virological diagnosis during the 2-week universal LFD evaluation period compared to 77% with targeted POC-RT-PCR deployment alone, on background of approximately one-third having an NHS Track and Trace RT-PCR test-result at presentation. LFD sensitivity and specificity was 70.7% and 99.1% respectively providing a PPV of 97.7% and NPV of 86.4% with disease prevalence of 34.7%. ED discharge-delays (breaches) attributable to COVID-19 fell to 33/3532 (0.94%) compared with the preceding POC-RT-PCR period (107/4114 (2.6%); p=<0.0001). Importantly, LFD testing identified 1 or 2 clinically-unsuspected COVID-19 patients/day. Three clinically-confirmed LFD false positive patients were appropriately triaged based on LFD action-card flowchart, and only 5 of 95 false-negative LFD results were inappropriately admitted to non-COVID-19 areas where no onward-transmission was identified. LFD testing was restricted to asymptomatic patients when disease prevalence fell below 5% and detected 1–3 cases/week. Conclusion: Universal SARS-CoV-2 LFD testing can be safely and effectively deployed in ED alongside POC-RT-PCR testing during periods of high and low disease prevalence.B. MerrickM. NoronhaR. BatraS. DouthwaiteG. NebbiaL.B. SnellS. PickeringR.P. GalaoJ. WhitfieldA. JahangeerR. GunawardenaT. GodfreyR. LaifaK. WebberP.R. CliffE. CunninghamS.J.D. NeilH. GettingsJ.D. EdgeworthH.L. HarrisonElsevierarticleSARS-CoV-2Lateral flow viral antigen detection devicesLFDEmergency departmentNosocomial transmissionInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENInfection Prevention in Practice, Vol 3, Iss 4, Pp 100186- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	SARS-CoV-2 Lateral flow viral antigen detection devices LFD Emergency department Nosocomial transmission Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	SARS-CoV-2 Lateral flow viral antigen detection devices LFD Emergency department Nosocomial transmission Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 B. Merrick M. Noronha R. Batra S. Douthwaite G. Nebbia L.B. Snell S. Pickering R.P. Galao J. Whitfield A. Jahangeer R. Gunawardena T. Godfrey R. Laifa K. Webber P.R. Cliff E. Cunningham S.J.D. Neil H. Gettings J.D. Edgeworth H.L. Harrison Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19
description	Summary: Background: Point-of-care (POC) SARS-CoV-2 lateral-flow antigen detection (LFD) testing in the emergency department (ED) could inform rapid infection control decisions but requirements for safe deployment have not been fully defined Methods: Review of LFD test results, laboratory and POC-RT-PCR results and ED-performance metrics during a two-week high SARS-CoV-2 prevalence period followed by several months of falling prevalence. Aim: Determine whether LFD testing can be safely deployed in ED to provide an effective universal SARS-CoV-2 testing capability. Findings: 93% (345/371) of COVID-19 patients left ED with a virological diagnosis during the 2-week universal LFD evaluation period compared to 77% with targeted POC-RT-PCR deployment alone, on background of approximately one-third having an NHS Track and Trace RT-PCR test-result at presentation. LFD sensitivity and specificity was 70.7% and 99.1% respectively providing a PPV of 97.7% and NPV of 86.4% with disease prevalence of 34.7%. ED discharge-delays (breaches) attributable to COVID-19 fell to 33/3532 (0.94%) compared with the preceding POC-RT-PCR period (107/4114 (2.6%); p=<0.0001). Importantly, LFD testing identified 1 or 2 clinically-unsuspected COVID-19 patients/day. Three clinically-confirmed LFD false positive patients were appropriately triaged based on LFD action-card flowchart, and only 5 of 95 false-negative LFD results were inappropriately admitted to non-COVID-19 areas where no onward-transmission was identified. LFD testing was restricted to asymptomatic patients when disease prevalence fell below 5% and detected 1–3 cases/week. Conclusion: Universal SARS-CoV-2 LFD testing can be safely and effectively deployed in ED alongside POC-RT-PCR testing during periods of high and low disease prevalence.
format	article
author	B. Merrick M. Noronha R. Batra S. Douthwaite G. Nebbia L.B. Snell S. Pickering R.P. Galao J. Whitfield A. Jahangeer R. Gunawardena T. Godfrey R. Laifa K. Webber P.R. Cliff E. Cunningham S.J.D. Neil H. Gettings J.D. Edgeworth H.L. Harrison
author_facet	B. Merrick M. Noronha R. Batra S. Douthwaite G. Nebbia L.B. Snell S. Pickering R.P. Galao J. Whitfield A. Jahangeer R. Gunawardena T. Godfrey R. Laifa K. Webber P.R. Cliff E. Cunningham S.J.D. Neil H. Gettings J.D. Edgeworth H.L. Harrison
author_sort	B. Merrick
title	Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19
title_short	Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19
title_full	Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19
title_fullStr	Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19
title_full_unstemmed	Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19
title_sort	real-world deployment of lateral flow sars-cov-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of covid-19
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/a045b9a13c7740cf86e2666a29fd91c2
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Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19

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