A study to assess the impact of cobas Liat point-of-care PCR assays (SARS-CoV-2 and Influenza A/B) on patient clinical management in the emergency department of the University of California at Davis Medical Center

Abstract

Background Rapid detection of SARS-CoV-2 is crucial for reduction of transmission and clinical decision-making. The cobas® SARS-CoV-2 & Influenza A/B nucleic acid test for use on the cobas Liat® System is a rapid (20 minutes) point-of-care (POC) polymerase chain reaction (PCR) method. Methods This unblinded, pre-post study enrolled consecutive patients with symptoms/signs consistent with SARS-CoV-2 infection presenting to the University of California, Davis emergency department (ED). Outcomes following implementation of the cobas Liat SARS-CoV-2 & Influenza A/B test (intervention period: December 2020 to May 2021) were compared with previous standard-of-care using centralized laboratory PCR methods (control period: April 2020 to October 2020). Results Electronic health records of 8879 symptomatic patients were analyzed, comprising 4339 and 4540 patient visits and 538 and 638 positive SARS-CoV-2 PCR test results in the control and intervention periods, respectively. Compared with the control period, turnaround time (TAT) was shorter in the intervention period (median 0.98 vs 12.3 hours; p<0.0001). ED length of stay (LOS) was generally longer in the intervention period compared with the control period, but for those SARS-CoV-2-negative who were admitted, ED LOS was shorter (median 12.53 vs 17.93 hours; p<0.0001). Overall, the rate of anti-infective prescribing was also lower in the intervention period than in the control period (antibiotics only: 38.11% vs 44.55%; p<0.0001 and antivirals only: 3.13% vs 0.94%; p<0.0001). Conclusion This real-world study confirms faster TAT with a POC PCR method in an emergency care setting and highlights the importance of rapid SARS-CoV-2 detection to aid patient management and inform treatment decisions.

Effectiveness of SARS‐CoV‐2 testing strategies: A scoping review

“…Among the 17 included studies, six were published in 2021 [29–34], and the remaining 11 studies [35–45] were published in 2022. The study design of the included studies were randomized controlled trials [32, 34, 41], nonrandomized experimental studies [31, 33, 36], cohort studies [35, 42, 43], cross‐sectional studies [38–40, 44], self‐controlled case series (SCCS) [30], and economic evaluations [29, 37, 45]. Among the randomized controlled trials, two were cluster randomized controlled trials [32, 34].…”

“…Six of the studies considered symptomatic and asymptomatic individuals [29, 31, 33, 38, 39, 42], of which three studies also considered asymptomatic contacts [33, 39, 42]. Two studies focused on asymptomatic contacts only [32, 41], four studies focused on symptomatic individuals only [35, 36, 40, 43], one study focused on both symptomatic individuals and asymptomatic contacts [44], two studies focused on asymptomatic individuals only [34, 45], and two studies did not specify symptom status [30, 37]. Only one study specifically mentioned healthcare workers as participants, in addition to the general community [38].…”

“…Most studies ( n = 8) were conducted in healthcare facilities [29, 30, 35, 36, 40, 43–45]. Four studies were conducted in the community [31, 33, 39, 41].…”

“…Six of the included studies were conducted with an adult population only [29, 30, 35, 36, 38, 41]. Three studies focused on children only [33, 40, 44].…”

“…Most of the studies included both males and females, although information on the sex of participants was not provided in five studies [37, 38, 42, 44, 45]. Ethnicity was specified in seven studies [32, 33, 36, 38–41], while socioeconomic status was mentioned in only one study [41]. The education level attained by individuals was reported in three studies conducted in school settings, focusing on school students [32, 34, 42].…”