Negative predictive value of the FebriDx host response point-of-care test in patients presenting to a single Australian emergency department with suspected COVID-19: an observational diagnostic accuracy study

• Published in: BMJ open 2022-12, Vol.12 (12), p.e065568-e065568
• Main Authors: Buntine, Paul, Miller, Joseph, Pope, Alun, Guy, Stephen, Wong, Fang Qi Alex, McDonald, Hannah, Ahmed, Mania, Teow, Kang Hui, Roney, Morgan, Mohammadi, Farzaneh, Aldridge, Emogene, Hackett, Liam, Jenner, Susanna, Davis, Belinda
• Format: Article
• Language: English
• Subjects: Accuracy; Adolescent; Adult; Asymptomatic; Australia - epidemiology; Consent; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 Vaccines; Emergency medical care; Emergency Medicine; Emergency Service, Hospital; Female; Fever; Hospitals; Humans; Immunization; Infections; Male; Medical diagnosis; Pandemics; Patients; Point-of-Care Testing; Predictive Value of Tests; Proteins; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-065568

To determine the negative predictive value (NPV) of the FebriDx point-of-care host response device in patients presenting with symptoms suggestive of COVID-19 infection in a mostly immunised Australian emergency department (ED) population during the late 2021 phase of the COVID-19 pandemic. Observational diagnostic accuracy study comparing FebriDx point-of-care test to SARS-CoV-2 PCR. An ED in Melbourne, Australia, with 63 000 annual presentations in 2021. Patients aged 16 and over who met the Victorian Department of Health case definition for suspected COVID-19 infection PCR testing. Patients meeting any of the following criteria were excluded: 14 days prior to testing; current immunosuppressive or interferon therapy; live immunisation within the last 30 days; fever lasting>7 days; antibiotic or antiviral use in the preceding 14 days; experience of major trauma, major surgical intervention or severe burns within the last 30 days. COVID-19 PCR results (detected, not detected) and FebriDx results (bacterial positive, viral negative, viral positive). 94 participants were enrolled (female: 46; male: 48), 34% of participants (tested positive for COVID-19 according to PCR results, with a background incidence among all adult ED attenders of 2.5%. The sensitivity of FebriDx for detection of COVID-19 was 56% (95% CI 40% to 100%) and specificity was 92% (95% CI 84% to 100%). For the population tested, this resulted in an NPV of 80% (95% CI 71% to 100%) and a positive predictive value of 78% (95% CI 60% to 100%). In the context of a population with low COVID-19 infection rates, an evolved variant of COVID-19 and a very high community COVID-19 vaccination rate, FebriDx demonstrated reduced sensitivity and NPV relative to results from earlier international tests. These contextual factors should be considered during any attempt to generalise the current results. ACTRN12620001029987 (Australian Clinical Trials).