Routine point-of-care COVID-19 testing may reduce time to results, improve infection control

Rapid bedside testing is faster than standard centralized laboratory polymerase chain reaction testing for COVID-19 and may improve infection control in the hospital, according to data published in The Lancet Respiratory Medicine.

“The long delays associated with centralized laboratory polymerase chain reaction testing are recognized as a major challenge for hospitals in effectively responding to the COVID-19 pandemic, and mitigation strategies are urgently required in preparation for the probable second wave this winter,” Nathan J. Brendish, PhD, clinical lecturer in infectious diseases and general internal medicine at the School of Clinical and Experimental Sciences at the University of Southampton, U.K., and colleagues wrote. “To our knowledge, this study is the first to assess the clinical impact of molecular point-of-care testing for COVID-19 for acute admissions and shows that routine use of point-of-care testing can deliver rapid, accurate and actionable results to clinical and infection control teams.”

Researchers conducted the prospective, interventional, nonrandomized controlled COV-19POC study from March 20 to April 19 that included 1,054 adult patients that presented with suspected COVID-19 infection. Patients were recruited to a point-of-care testing group (n = 499) and had nose and throat swabs tested by the QIAstat-Dx Respiratory SARS-CoV-2 Panel or a control group (n = 555) that was tested by central laboratory polymerase chain reaction (PCR).

The primary outcome was time to results in the overall cohort.

In the point-of-care testing group, 197 (39%) patients tested positive for COVID-19 compared with 155 (28%) patients in the control group (difference, 11.5 percentage points; 95% CI, 5.8-17.2; P = .0001).

Median time to results was 1.7 hours in the point-of-care testing group and 21.3 hours in the control group (difference, 19.6 hours; 95% CI, 19-20.3; P < .0001). Cox proportional hazards regression models showed time to results in the point-of-care testing group was significantly shorter compared with the control group (HR = 4,023; 95% CI, 545-29,696; P < .0001).

After testing, patients were transferred to definitive COVID-positive or negative wards. This took 8 hours in the point-of-care testing group and 28.8 hours in the control group; 13.7% of patients were transferred directly to the correct ward and bypassed assessment areas in the point-of-care testing group compared with 0% in the control group. The mean number of bed moves between admission and final ward arrival was 0.9 in the point-of-care testing group and 1.4 moves in the control group, according to a press release.

In other results, 469 point-of-care tests were assessed for diagnostic accuracy and had 99.4% sensitivity and 98.6% specificity, which the researchers said outperformed central laboratory PCR (85.9% sensitivity; 98.9% specificity), according to the release.

According to the researchers, point-of-care testing could also be used for assessing elective hospital admissions, primary care patients, hospital staff, care home staff and residents, airport screening, school screening and population-level screening.

“Resources should urgently be made available to support the implementation of appropriate point-of-care testing platforms in emergency departments and admission units in hospitals in preparation for the next phase of the pandemic,” the researchers wrote.