Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19

Merrick, Blair; Noronha, Michelle; Batra, Rahul; Douthwaite, Sam; Nebbia, Gaia; Snell, Luke B; Pickering, Suzanne; Galão, Rui Pedro; Whitfield, Jennifer; Jahangeer, A.; Gunawardena, Ramith; Godfrey, Thomas; Laifa, R.; Webber, Krysten; Cliff, Penelope R.; Cunningham, Emma; Neil, Stuart; Gettings, H.; Edgeworth, Jonathan D; Harrison, Hooi-Ling

doi:10.1016/j.infpip.2021.100186

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…Furthermore, even though many healthcare centers divided the COVID-19-unsuspected and COVID-19-suspected patients to different ED sites, our study best demonstrates the risk reduction for COVID-19-negative patients to be exposed to COVID-19-positive patients in either of the ED sites. In addition, the comparison between two study periods, one of them before the introduction of Ag-RDTs to the ED as part of the triage protocol, and one after, is unique to our research [ 17 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of Rapid COVID-19 Antigen Test in the Emergency Department as a Decision-Support Tool

et al. 2023

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The emergency department (ED) is the initial point of contact between hospital staff and patients potentially infected with SARS-CoV-2, thus, prevention of inadvertent exposure to other patients is a top priority. We aimed to assess whether the introduction of antigen-detecting rapid diagnostic tests (Ag-RDTs) to the ED affected the likelihood of unwanted SARS-CoV-2 exposures. In this retrospective single-center study, we compared the rate of unwarranted exposure of uninfected adult ED patients to SARS-CoV-2 during two separate research periods; one before Ag-RDTs were introduced, and one with Ag-RDT used as a decision-support tool. The introduction of Ag-RDTs to the ED significantly decreased the relative risk of SARS-CoV-2-negative patients being incorrectly assigned to the COVID-19 designated site (“red ED”), by 97%. There was no increase in the risk of SARS-CoV-2-positive patients incorrectly assigned to the COVID-19-free site (“green ED”). In addition, duration of ED admission was reduced in both the red and the green ED. Therefore, implementing the Ag-RDT-based triage protocol proved beneficial in preventing potential COVID-19 nosocomial transmission.

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Section: Discussionmentioning

confidence: 99%

The Use of Rapid COVID-19 Antigen Test in the Emergency Department as a Decision-Support Tool

et al. 2023

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“…LFTs were adopted on an unprecedented scale during the COVID-19 pandemic, demonstrating their feasibility and acceptability on a global basis. LFTs have had multiple clinical and public health use cases 20,21 , such as testing to confirm diagnosis in symptomatic individuals, testing to screen asymptomatic individuals with known exposures or in high-risk groups, such as healthcare workers, care home (elder home) workers, or first responders, screening of asymptomatic individuals at schools, workplaces or mass gatherings, air, land or sea border testing to slow the introduction of new variants, testing to determine the effectiveness of anti-viral treatment, testing for surveillance, and infection-control-based testing in healthcare facilities to facilitate flow of patients 22,23 .…”

Section: Large-scale Testingmentioning

confidence: 99%

Lateral flow test engineering and lessons learned from COVID-19

et al. 2023

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The acceptability and feasibility of large-scale testing with lateral flow tests (LFTs) for clinical and public health purposes has been demonstrated during the COVID-19 pandemic. LFTs can detect analytes in a variety of samples, providing a rapid read-out, which allows selftesting and decentralized diagnosis. In this Review, we examine the changing LFT landscape with a focus on lessons learned from COVID-19. We discuss the implications of LFTs for decentralized testing of infectious diseases, including diseases of epidemic potential, the 'silent pandemic' of antimicrobial resistance, and other acute and chronic infections. Bioengineering approaches will play a key part in increasing the sensitivity and specificity of LFTs, improving sample preparation, incorporating nucleic acid amplification and detection, and enabling multiplexing, digital connection and green manufacturing, with the aim of creating the next generation of high-accuracy, easy-to-use, affordable and digitally connected LFTs. We conclude with recommendations, including the building of a global network of LFT research and development hubs to facilitate and strengthen future diagnostic resilience. Sections• Bioengineering approaches, such as the use of nano-and quantum materials, nucleic-acid-based LFTs, CRISPR and machine learning, will improve the sensitivity, specificity, multiplexing and connectivity features of LFTs.• We recommend investing in an international LFT research and development hub network to spearhead the development of a pipeline of innovative bioengineering approaches to design next-generation LFTs.

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“…Real-time reverse transcription–polymerase chain reaction (qRT-PCR) of samples from nasopharyngeal swabs, sputum, various lower respiratory tract secretions, and saliva of patients is the most widely used diagnostic method for COVID-19 diagnosis [ 3 ]. Nevertheless, its adoption has been hindered by factors such as high cost, limited scalability, personnel training, and quality control measures [ 4 ]. Using the lateral flow assay (LFA) to diagnose SARS-CoV-2 infection offers a potential point-of-care option that may be obtained in near-infinite quantities and performed at the bedside in 10 min.…”

Section: Introductionmentioning

confidence: 99%

“…Using the lateral flow assay (LFA) to diagnose SARS-CoV-2 infection offers a potential point-of-care option that may be obtained in near-infinite quantities and performed at the bedside in 10 min. However, its use in clinical settings has been under debate owing to its low sensitivity compared to qRT-PCR [ 5 ], and it requires an experienced operator, which influences the test performance [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Highly Sensitive and Quantitative Diagnosis of SARS-CoV-2 Using a Gold/Platinum Particle-Based Lateral Flow Assay and a Desktop Scanning Electron Microscope

et al. 2022

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The gold standard test for identifying SARS-CoV-2, the causative agent of COVID-19, is polymerase chain reaction (PCR). Despite their limited sensitivity, SARS-CoV-2 antigen rapid diagnostic tests are vital tools in the fight against viral spread. Owing to its simplicity and low cost, the lateral flow assay (LFA) is the most extensively used point-of-care diagnostic test. Here, we report a newly designed LFA-NanoSuit method (LNSM) that works in conjunction with desktop scanning electron microscopy (SEM) to detect SARS-CoV-2. LNSM requires no standard SEM treatment, avoids cellulose and residual buffer deformation, and enables the capture of high-resolution images of antibody-labeled gold/platinum particles reacting with SARS-CoV-2 antigens. To assess its applicability, we compared clinical SARS-CoV-2 samples via visual detection of LFA, LSNM detection of LFA, and real-time reverse transcription-PCR (qRT-PCR). Compared to qRT-PCR, LNSM showed 86.7% sensitivity (26/30; 95% confidence interval (CI): 69.28–96.24%) and 93.3% specificity (14/15; 95% CI: 68.05–99.83%) for SARS-CoV-2. In samples with a relatively low SARS-CoV-2 RNA copy number (30 < Ct ≤ 40), the sensitivity of LNSM was greater (73.3%) than that of visual detection (0%). A simple, sensitive, and quantitative LNSM can be used to diagnose SARS-CoV-2.

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Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19

Cited by 8 publications

References 18 publications

The Use of Rapid COVID-19 Antigen Test in the Emergency Department as a Decision-Support Tool

The Use of Rapid COVID-19 Antigen Test in the Emergency Department as a Decision-Support Tool

Lateral flow test engineering and lessons learned from COVID-19

Highly Sensitive and Quantitative Diagnosis of SARS-CoV-2 Using a Gold/Platinum Particle-Based Lateral Flow Assay and a Desktop Scanning Electron Microscope

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