Point of Care Nucleic Acid Testing for SARS-CoV-2 in Hospitalized Patients: A Clinical Validation Trial and Implementation Study

• Main Authors: Dami A. Collier, Sonny M. Assennato, Ben Warne, Nyarie Sithole, Katherine Sharrocks, Allyson Ritchie, Pooja Ravji, Matthew Routledge, Dominic Sparkes, Jordan Skittrall, Anna Smielewska, Isobel Ramsey, Neha Goel, Martin Curran, David Enoch, Rhys Tassell, Michelle Lineham, Devan Vaghela, Clare Leong, Hoi Ping Mok, John Bradley, Kenneth G.C. Smith, Vivienne Mendoza, Nikos Demiris, Martin Besser, Gordon Dougan, Paul J. Lehner, Mark J. Siedner, Hongyi Zhang, Claire S. Waddington, Helen Lee, Ravindra K. Gupta, Stephen Baker, Ian Goodfellow, Paul Lyons, Nicholas J. Matheson, Mark Toshner, Michael P. Weekes, Nick Brown, Surendra Palmar, Daniel Chapman, Ashley Shaw, Vivien Mendoza, Sherly Jose, Areti Bermperi, Julie Ann Zerrudo, Evgenia Kourampa, Caroline Saunders, Ranalie de Jesus, Jason Domingo, Ciro Pasquale, Bensi Vergese, Phoebe Vargas, Marivic Fabiculana, Marlyn Perales, Richard Skells, Lee Mynott, Elizabeth Blake, Amy Bates, Anne-laure Vallier, Alexandra Williams, David Phillips, Edmund Chiu, Alex Overhill, Nicola Ramenante, Jamal Sipple, Steven Frost, Helena Knock, Richard Hardy, Emily Foster, Fiona Davidson, Viona Rundell, Purity Bundi, Richmond Abeseabe, Sarah Clark, Isabel Vicente
• Format: Article
• Language: English
• Published: Elsevier 2020-08-01
• Series: Cell Reports Medicine
• Subjects: COVID-19; SARS-CoV-2; POC; point of care; diagnostic test; nosocomial
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666379120300781
• ISSN: 2666-3791

Summary: There is an urgent need for rapid SARS-CoV-2 testing in hospitals to limit nosocomial spread. We report an evaluation of point of care (POC) nucleic acid amplification testing (NAAT) in 149 participants with parallel combined nasal and throat swabbing for POC versus standard lab RT-PCR testing. Median time to result is 2.6 (IQR 2.3–4.8) versus 26.4 h (IQR 21.4–31.4, p < 0.001), with 32 (21.5%) positive and 117 (78.5%) negative. Cohen’s κ correlation between tests is 0.96 (95% CI 0.91–1.00). When comparing nearly 1,000 tests pre- and post-implementation, the median time to definitive bed placement from admission is 23.4 (8.6-41.9) versus 17.1 h (9.0–28.8), p = 0.02. Mean length of stay on COVID-19 “holding” wards is 58.5 versus 29.9 h (p < 0.001). POC testing increases isolation room availability, avoids bed closures, allows discharge to care homes, and expedites access to hospital procedures. POC testing could mitigate the impact of COVID-19 on hospital systems.