1. Optimisation of COVID‐19 diagnostic pathways in acute hospital admissions to prevent nosocomial transmission
- Author
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Livingstone, Robert, Woodhead, Alexander, Bhandari, Megha, Dias, James, Smith, Trevor, Havelock, Tom, and Stammers, Matthew
- Subjects
Pulmonary and Respiratory Medicine ,Cross Infection ,COVID-19 Testing ,SARS-CoV-2 ,COVID-19 ,Humans ,Immunology and Allergy ,Pandemics ,Sensitivity and Specificity ,Hospitals ,Genetics (clinical) ,Retrospective Studies - Abstract
Introduction: In the management of acute hospital admissions during the COVID-19 pandemic, safe patient cohorting depends on robust admission diagnostic strategies. It is essential that screening strategies are sensitive and rapid, to prevent nosocomial transmission of COVID-19 and maintain patient flow. Methods: We retrospectively identified all COVID-19 positive and suspected cases at our institution screened by reverse transcription polymerase chain reaction (RT-PCR) between 4 April and 28 June 2020. Using RT-PCR positivity within 7 days as our reference standard, we assessed sensitivity and net-benefit of three admission screening strategies: single admission RT-PCR, composite admission RT-PCR and CXR and repeat RT-PCR with 48 h. Results: RT-PCR single-test sensitivity was 91.5% (87.8%-94.4%) versus 97.7% (95.4%-99.1%) (p = 0.025) for RT-PCR/CXR composite testing and 95.1% (92.1%-97.2%) (p = 0.03) for repeated RT-PCR. Net-benefit was 0.83 for single RT-PCR versus 0.89 for RT-PCR/CXR and 0.87 for repeated RT-PCR at 0.02% threshold probability. Conclusion: The RT-PCR/CXR composite testing strategy was highly sensitive when screening patients at the point of hospital admission. Real-world sensitivity of this approach was comparable to repeat RT-PCR testing within 48 h; however, faster facilitating improved patient flow.
- Published
- 2022