Wiencek Joesph R, Head Carter L, Sifri Costi D, Parsons Andrew S
Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
Laboratory Stewardship Committee, University of Virginia Health, Charlottesville, Virginia, USA.
Open Forum Infect Dis. 2020 Oct 9;7(10):ofaa406. doi: 10.1093/ofid/ofaa406. eCollection 2020 Oct.
The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance.
We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC).
Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% ( < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs.
Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.
引发2019冠状病毒病（COVID - 19）的新型严重急性呼吸综合征冠状病毒2（SARS-CoV-2）于2019年12月出现，目前已在美国感染了近500万人。2020年春季，尽管循证指南有限，但私立实验室和一些医院仍开始进行抗体检测。
我们对2020年5月14日至2020年6月15日在一家大型学术医疗中心接受SARS-CoV-2抗体检测的患者进行了回顾性病历审查。该中心是美国首批为个体临床医生提供抗体检测能力的机构之一，目的是将临床医生描述的抗体检测指征与美国传染病学会（IDSA）和疾病控制与预防中心（CDC）当前基于专家的指南进行比较。
在444份个体抗体检测结果中，除公共卫生流行病学研究（n = 223）外，最常描述的检测指征是患有现已康复的符合COVID - 19疾病且此前未进行分子检测的患者（n = 105），以及被认为曾接触过患有符合COVID - 19疾病患者的无症状患者（n = 60）。与当前IDSA和CDC指南一致的检测指征中，SARS-CoV-2抗体检测阳性率为17%，而与该指南不一致的检测指征中阳性率为5%（P <.0001）。与当前基于专家的指南不一致的检测占检测成本的近一半。
我们的研究结果表明，临床医生描述的检测指征与基于专家的指南之间存在脱节，且这两组之间的阳性检测率存在显著差异。临床好奇心和患者偏好似乎在检测决策中发挥了重要作用，并在很大程度上导致了检测成本。
