eprintid: 10133522 rev_number: 16 eprint_status: archive userid: 608 dir: disk0/10/13/35/22 datestamp: 2021-08-27 07:22:33 lastmod: 2021-11-30 23:21:24 status_changed: 2021-08-27 07:22:33 type: article metadata_visibility: show creators_name: Houston, H creators_name: Deas, G creators_name: Naik, S creators_name: Shah, K creators_name: Patel, S creators_name: Dottori, MG creators_name: Tay, M creators_name: Filson, SA creators_name: Biggin-Lamming, J creators_name: Ross, J creators_name: Vaughan, N creators_name: Vaid, N creators_name: Rao, GG creators_name: Amin, AK creators_name: Gupta-Wright, A creators_name: John, L 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 ispublished: pub divisions: UCL divisions: B02 divisions: D01 keywords: Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, COVID-19, molecular diagnostics, infection control note: © 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. 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. date: 2021-08-09 date_type: published publisher: BMJ PUBLISHING GROUP official_url: https://doi.org/10.1136/bmjopen-2021-049179 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1883542 doi: 10.1136/bmjopen-2021-049179 lyricists_name: Gupta-Wright, Ankur lyricists_id: AGUPT85 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: BMJ Open volume: 11 number: 8 article_number: e049179 pages: 9 issn: 2044-6055 citation: Houston, H; Deas, G; Naik, S; Shah, K; Patel, S; Dottori, MG; Tay, M; ... John, L; + view all <#> Houston, H; Deas, G; Naik, S; Shah, K; Patel, S; Dottori, MG; Tay, M; Filson, SA; Biggin-Lamming, J; Ross, J; Vaughan, N; Vaid, N; Rao, GG; Amin, AK; Gupta-Wright, A; John, L; - view fewer <#> (2021) Utility of the FebriDx point-of-care assay in supporting a triage algorithm for medical admissions with possible COVID-19: an observational cohort study. BMJ Open , 11 (8) , Article e049179. 10.1136/bmjopen-2021-049179 <https://doi.org/10.1136/bmjopen-2021-049179>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10133522/1/e049179.full.pdf