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7th January 2022
The use of a point-of-care (POC) COVID-19 test within an emergency department (ED) has been found to significantly reduce the turn-around- time compared to PCR tests among patients in need of hospital treatment. This was the key finding of an analysis by a team from the Department of Emergency and Acute Medicine, Charite Universitatsmedizin, Berlin, Germany.
The COVID-19 pandemic has placed enormous strain on healthcare systems across the globe and this has been particularly true for emergency departments (EDs) since patients, even with mild symptoms tend to intuitively present at an ED when they believe they have a serious disease. An ED therefore requires access to a fast and accurate means of testing patients for COVID-19 when they present at the department. The gold standard test for COVID-19 is a PCR test although results are not available for between 4 and 24 hours . The use of rapid antigen tests offers a potentially faster alternative but research has shown that while these tests are useful for symptomatic patients in the emergency setting, patients testing negative require confirmation by PCR test and should isolate until this result becomes available.
With a need for a rapid COVID-19 test result among all patients potentially requiring urgent inpatient care, for the present study, the German team set out to evaluate the role of a POC COVID-19 test for use in the ED. All inpatients were routinely screened at the researcher’s hospital for COVID-19 and they retrospectively examined the clinical characteristics and in-hospital follow-up data for all patients from the electronic medical records. For the study, the team set the primary outcome measure as the turn-around-time (TAT) for the POC compared to the standard PCR test result as well as examining the diagnostic performance of the device which was integrated with the hospital LAN system and ordered via the laboratory channel and ED.
A population of 160 patients with a mean age of 68 years (69% female) were included and of whom, 16 tested positive for COVID-19 using the POC. The most common symptoms of COVID-19 were dyspnoea (37.5%), fever and cough (both 25%).
The POC had a sensitivity and specificity of 100% and the test result was available within a median of 102 minutes after admission compared to a median of 811 minutes for the PCR test (p < 0.001). Among patients requiring an intervention within 6 hours of presentation (e.g., severe trauma, myocardial infarction), the POC test result was available before the intervention in 92.1% of patients compared to only 5.4% of those with a PCR test result.
The authors concluded that the device could be easily incorporated into an ED and that it showed a high diagnostic performance.
Mockel M et al. SARS-CoV-2 screening in patients in need of urgent inpatient treatment in the Emergency Department (ED) by digitally integrated point-of-care PCR: a clinical cohort study. MedRxiv 2022