Emergency Department, Hospital of Merano (SABES-ASDAA), Merano, Italy.
Emergency Department, Hospital of Merano (SABES-ASDAA), Merano, Italy.
Am J Emerg Med. 2022 Jan;51:92-97. doi: 10.1016/j.ajem.2021.10.022. Epub 2021 Oct 22.
Early detection of SARS-CoV-2 patients is essential to contain the pandemic and keep the hospital secure. The rapid antigen test seems to be a quick and easy diagnostic test to identify patients infected with SARS-CoV-2. To assess the possible role of the antigen test in the Emergency Department (ED) assessment of potential SARS-CoV-2 infection in both symptomatic and asymptomatic patients.
Between 1 July 2020 and 10 December 2020, all patients consecutively assessed in the ED for suspected COVID-19 symptoms or who required hospitalisation for a condition not associated with COVID-19 were subjected to a rapid antigen test and RT-PCR swab. The diagnostic accuracy of the antigen test was determined in comparison to the SARS-CoV-2 PCR test using contingency tables. The possible clinical benefit of the antigen test was globally evaluated through decision curve analysis (DCA).
A total of 3899 patients were subjected to antigen tests and PCR swabs. The sensitivity, specificity and accuracy of the antigen test were 82.9%, 99.1% and 97.4% (Cohen's K = 0.854, 95% CI 0.826-0.882, p < 0.001), respectively. In symptomatic patients, sensitivity was found to be 89.8%, while in asymptomatic patients, sensitivity was 63.1%. DCA appears to confirm a net clinical benefit for the preliminary use of antigen tests.
The antigen test performed in the ED, though not ideal, can improve the overall identification of infected patients. While it appears to perform well in symptomatic patients, in asymptomatic patients, although it improves their management, it seems not to be definitive.
早期发现 SARS-CoV-2 患者对于控制疫情和确保医院安全至关重要。快速抗原检测似乎是一种快速简便的诊断检测方法，可用于识别感染 SARS-CoV-2 的患者。本研究旨在评估抗原检测在急诊科（ED）评估疑似 SARS-CoV-2 感染患者中的潜在作用，包括有症状和无症状患者。
2020 年 7 月 1 日至 12 月 10 日，对连续在 ED 就诊的疑似 COVID-19 症状患者或因与 COVID-19 无关的疾病而需要住院治疗的患者进行快速抗原检测和 RT-PCR 拭子检测。使用列联表比较抗原检测与 SARS-CoV-2 PCR 检测的诊断准确性。通过决策曲线分析（DCA）综合评估抗原检测的可能临床获益。
共对 3899 例患者进行了抗原检测和 PCR 拭子检测。抗原检测的敏感性、特异性和准确性分别为 82.9%、99.1%和 97.4%（Cohen's K=0.854，95%CI 0.826-0.882，p<0.001）。在有症状患者中，敏感性为 89.8%，在无症状患者中，敏感性为 63.1%。DCA 似乎证实了抗原检测初步使用的净临床获益。
ED 中进行的抗原检测虽然并不理想，但可以提高感染患者的整体识别率。虽然在有症状患者中表现良好，但在无症状患者中，虽然可以改善管理，但似乎不能确定。
