@article{discovery10133522, note = {{\copyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.}, publisher = {BMJ PUBLISHING GROUP}, month = {August}, journal = {BMJ Open}, year = {2021}, volume = {11}, number = {8}, title = {Utility of the FebriDx point-of-care assay in supporting a triage algorithm for medical admissions with possible COVID-19: an observational cohort study}, keywords = {Science \& Technology, Life Sciences \& Biomedicine, Medicine, General \& Internal, General \& Internal Medicine, COVID-19, molecular diagnostics, infection control}, issn = {2044-6055}, abstract = {Objective: To evaluate a triage algorithm used to identify and isolate patients with suspected COVID-19 among medical patients needing admission to hospital using simple clinical criteria and the FebriDx assay. Design:: Retrospective observational cohort. Setting Large acute National Health Service hospital in London, UK. Participants: All medical admissions from the emergency department between 10 August 2020 and 4 November 2020 with a valid SARS-CoV-2 RT-PCR result. Interventions: Medical admissions were triaged as likely, possible or unlikely COVID-19 based on clinical criteria. Patients triaged as possible COVID-19 underwent FebriDx lateral flow assay on capillary blood, and those positive for myxovirus resistance protein A (a host response protein) were managed as likely COVID-19. Primary outcome measures: Diagnostic accuracy (sensitivity, specificity and predictive values) of the algorithm and the FebriDx assay using SARS-CoV-2 RT-PCR from nasopharyngeal swabs as the reference standard. Results: 4.0\% (136) of 3443 medical admissions had RT-PCR confirmed COVID-19. Prevalence of COVID-19 was 46\% (80/175) in those triaged as likely, 4.1\% (50/1225) in possible and 0.3\% (6/2033) in unlikely COVID-19. Using a SARS-CoV-2 RT-PCR reference standard, clinical triage had sensitivity of 96\% (95\% CI 91\% to 98\%) and specificity of 61.5\% (95\% CI 59.8\% to 63.1\%), while the triage algorithm including FebriDx had sensitivity of 93\% (95\% CI 87\% to 96\%) and specificity of 86.4\% (95\% CI 85.2\% to 87.5\%). While 2033 patients were deemed not to require isolation using clinical criteria alone, the addition of FebriDx to clinical triage allowed a further 826 patients to be released from isolation, reducing the need for isolation rooms by 9.5 per day, 95\% CI 8.9 to 10.2. Ten patients missed by the algorithm had mild or asymptomatic COVID-19. Conclusions: A triage algorithm including the FebriDx assay had good sensitivity and was useful to 'rule-out' COVID-19 among medical admissions to hospital.}, url = {https://doi.org/10.1136/bmjopen-2021-049179}, author = {Houston, H and Deas, G and Naik, S and Shah, K and Patel, S and Dottori, MG and Tay, M and Filson, SA and Biggin-Lamming, J and Ross, J and Vaughan, N and Vaid, N and Rao, GG and Amin, AK and Gupta-Wright, A and John, L} }