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