FebriDx host response point-of-care testing improves patient triage for coronavirus disease 2019 (COVID-19) in the emergency department

• Published in: Infection control and hospital epidemiology 2022-08, Vol.43 (8), p.979-986
• Main Authors: Mansbridge, Christopher T., Tanner, Alex R., Beard, Kate R., Borca, Florina, Phan, Hang T.T., Brendish, Nathan J., Poole, Stephen, Hill, Christopher, Kiuber, Michael, Crouch, Robert, Waddington, Daniel, Clark, Tristan W.
• Format: Article
• Language: English
• Subjects: Accuracy; Antiviral Agents; Antiviral drugs; Coronaviruses; COVID-19; COVID-19 - diagnosis; Disease transmission; Emergency medical care; Emergency Service, Hospital; Humans; Infections; Mann-Whitney U test; Nosocomial infection; Observational studies; Original; Original Article; Pandemics; Patients; Point of care testing; R&D; Research & development; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Software; Triage - methods; Virus Diseases
• ISSN: 0899-823X; 1559-6834; 1559-6834
• DOI: 10.1017/ice.2021.531

Patients presenting to hospital with suspected coronavirus disease 2019 (COVID-19), based on clinical symptoms, are routinely placed in a cohort together until polymerase chain reaction (PCR) test results are available. This procedure leads to delays in transfers to definitive areas and high nosocomial transmission rates. FebriDx is a finger-prick point-of-care test (PoCT) that detects an antiviral host response and has a high negative predictive value for COVID-19. We sought to determine the clinical impact of using FebriDx for COVID-19 triage in the emergency department (ED). We undertook a retrospective observational study evaluating the real-world clinical impact of FebriDx as part of an ED COVID-19 triage algorithm. Emergency department of a university teaching hospital. Patients presenting with symptoms suggestive of COVID-19, placed in a cohort in a 'high-risk' area, were tested using FebriDx. Patients without a detectable antiviral host response were then moved to a lower-risk area. Between September 22, 2020, and January 7, 2021, 1,321 patients were tested using FebriDx, and 1,104 (84%) did not have a detectable antiviral host response. Among 1,104 patients, 865 (78%) were moved to a lower-risk area within the ED. The median times spent in a high-risk area were 52 minutes (interquartile range [IQR], 34-92) for FebriDx-negative patients and 203 minutes (IQR, 142-255) for FebriDx-positive patients (difference of -134 minutes; 95% CI, -144 to -122; < .0001). The negative predictive value of FebriDx for the identification of COVID-19 was 96% (661 of 690; 95% CI, 94%-97%). FebriDx improved the triage of patients with suspected COVID-19 and reduced the time that severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR-negative patients spent in a high-risk area alongside SARS-CoV-2-positive patients.