In hospitalized patients with coronavirus disease 2019 (COVID-19), the routine use of molecular point-of-care (POC) testing in emergency department (ED) admissions was associated with a large reduction in time to results, along with improvements in infection control measures, patient flow, and recruitment into clinical trials compared with the use of laboratory polymerase chain reaction (PCR) testing, according to study results published in The Lancet Respiratory Medicine.
A single-center, prospective, interventional, nonrandomized controlled study of POC testing in patients with suspected COVID-19 who presented to the ED or other acute areas of Southampton General Hospital (SGH) in the United Kingdom was conducted. Investigators sought to evaluate the clinical impact of molecular POC testing for COVID-19 in SGH — a secondary care facility — between March 20 and April 29, 2020, which was the first wave of the pandemic in the United Kingdom.
A total of 517 patients were assessed for eligibility, with 499 recruited to the POC testing group and evaluated with use of the QIAstat-Dx Respiratory SARS-CoV-2 Panel. Further, 555 contemporaneously tested patients were randomly assigned to the control group. Nasal and throat swabs were obtained at admission from participants in the POC group, whereas those in the control group were tested using laboratory PCR.
The primary study outcome measure was the time to results in the full cohort, which was defined as the time from COVID-19 testing being requested (ie, the time of recruitment for the POC testing group and the time laboratory testing was requested among the control participants) to the result being available to clinical teams. Prespecified secondary study outcomes included time from admission to arrival in a definitive clinical area (ie, a designed COVID-19-positive or COVID-19-negative ward), according to test results.
Both study groups were similar with respect to distribution of age, sex, and ethnicity. Overall, 39% (197 of 499) of patients in the POC testing group and 28% (155 of 555) of those in the control group tested positive for COVID-19, which was statistically significant (95% CI, 5.8-17.2; P =.0001). The median time to receiving test results was 1.7 hours (range, 1.6-1.9 hours) in the POC group vs 21.3 hours (range, 16.0-27.9 hours) in the control group (difference, 19.6 hours; 95% CI, 19.0-20.3 hours; P <.0001). Cox proportional hazard regression, which controlled for sex, age, time of presentation, and severity of disease, also demonstrated that the time to results was significantly shorter in the POC group compared with the control group (hazard ratio, 4023; 95% CI, 545 to 29,696; P <.0001).
The investigators concluded that in preparation for a second wave of COVID-19, efforts should now focus on improving access to and implementation of POC testing among patients being admitted to secondary care facilities.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Brendish NJ, Poole S, Naidu VV, et al. Clinical impact of molecular point-of-care testing for suspected COVID-19 in hospital (COV-19POC): a prospective, interventional, non-randomised, controlled study. Lancet Respir Med. Published online October 8, 2020. doi: 10.1016/S2213-2600(20)30454-9