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Utility of SARS-CoV-2 Rapid Antigen Testing for Patient Triage in the Emergency Department: A Clinical Implementation Study in Melbourne, Australia

19 Pages Posted: 2 Feb 2022

See all articles by Katherine Bond

Katherine Bond

University of Melbourne; University of Melbourne - Department of Microbiology

Ben Smith

University of Melbourne - Department of Emergency Medicine

Emma Gardiner

University of Melbourne - Department of Emergency Medicine

Kwee Chin Liew

University of Melbourne - Department of Microbiology

Eloise Williams

University of Melbourne - Department of Microbiology

Nicola Walsham

University of Melbourne - Department of Emergency Medicine

Mark Putland

University of Melbourne - Department of Emergency Medicine

Deborah Williamson

University of Melbourne - Department of Microbiology

More...

Abstract

Background: Early, rapid detection of SARS-CoV-2 is essential in healthcare settings in order to implement appropriate infection control precautions and rapidly assign patients to appropriate care pathways. Rapid testing methods, such as SARS-CoV-2 rapid antigen testing (RAT) may improve patient care, despite a lower sensitivity than real-time PCR (RT-PCR) testing.

Methods: Symptomatic patients presenting to an Emergency Department (ED) in Melbourne, Australia, were risk stratified for their likelihood of active COVID-19 infection, and tested by both Abbott Panbio™ COVID-12 Ag test and SARS-CoV-2 RT-PCR. Patients with a positive RAT in the ‘At or High Risk’ COVID-19 group were moved immediately to a COVID-19 ward rather than waiting for a RT-PCR result. Clinical and laboratory data were extracted to determine test performance characteristics and length of stay in the ED.

Findings: Analysis of 1762 paired RAT/RT-PCR samples demonstrated an overall sensitivity of 75.5% (95% CI: 69·9-80·4) for the Abbott Panbio™ COVID-12 Ag test, with specificity of 100% (95% CI: 99·8-100). Sensitivity improved with increasing risk for COVID-19 infection, from 72·4% (95% CI: 52·8-87·3) in the ‘No Risk’ cohort to 100% (95% CI: 29·2-100) in the ‘High Risk’ group. Time in the ED for the ‘At/High Risk’ group decreased from 421 minutes (IQR: 281, 525) to 274 minutes (140, 425), p = 0.02.

Interpretation: The positive predictive value of a positive RAT in this setting was high, allowing more rapid instigation of COVID-19 positive care pathways and an improvement in patient flow within the ED.

Funding Information: This work was funded by the Royal Melbourne Hospital, Melbourne, Australia.

Declaration of Interests: The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics Approval Statement: This study was approved as a quality assurance activity with Human Research Ethic Committee approval from the Royal Melbourne Hospital (QA2020085).

Keywords: SARS-CoV-2, Rapid antigen testing, Abbott Panbio, Emergency Department

Suggested Citation

Bond, Katherine and Smith, Ben and Gardiner, Emma and Liew, Kwee Chin and Williams, Eloise and Walsham, Nicola and Putland, Mark and Williamson, Deborah, Utility of SARS-CoV-2 Rapid Antigen Testing for Patient Triage in the Emergency Department: A Clinical Implementation Study in Melbourne, Australia. Available at SSRN: https://ssrn.com/abstract=4024202 or http://dx.doi.org/10.2139/ssrn.4024202

Katherine Bond (Contact Author)

University of Melbourne

185 Pelham Street
Carlton, 3053
Australia

University of Melbourne - Department of Microbiology ( email )

Melbourne
Australia

Ben Smith

University of Melbourne - Department of Emergency Medicine ( email )

Melbourne
Australia

Emma Gardiner

University of Melbourne - Department of Emergency Medicine ( email )

Melbourne
Australia

Kwee Chin Liew

University of Melbourne - Department of Microbiology ( email )

Melbourne
Australia

Eloise Williams

University of Melbourne - Department of Microbiology ( email )

Melbourne
Australia

Nicola Walsham

University of Melbourne - Department of Emergency Medicine ( email )

Melbourne
Australia

Mark Putland

University of Melbourne - Department of Emergency Medicine ( email )

Melbourne
Australia

Deborah Williamson

University of Melbourne - Department of Microbiology ( email )

Melbourne
Australia

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