Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
J Hosp Infect. 2022 May;123:92-99. doi: 10.1016/j.jhin.2022.02.010. Epub 2022 Feb 23.
Decisions to isolate patients at risk of having coronavirus disease 2019 (COVID-19) in the emergency department (ED) must be rapid and accurate to ensure prompt treatment and maintain patient flow whilst minimising nosocomial spread. Reverse transcription polymerase chain reaction (RT-PCR) assays are too slow to achieve this, and near-patient testing is being used increasingly to facilitate triage. The ID NOW severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) assay is an isothermal nucleic acid amplification near-patient test which targets the RNA-dependent RNA-polymerase gene.
To assess the diagnostic performance of ID NOW as a COVID-19 triage tool for medical admissions from the ED of a large acute hospital.
All adult acute medical admissions from the ED between 31 March and 31 July 2021 with valid ID NOW and RT-PCR results were included. The diagnostic accuracy of ID NOW [sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] was calculated against the laboratory reference standard. Discrepant results were explored further using cycle threshold values and clinical data.
Two percent (124/6050) of medical admissions were SARS-CoV-2 positive on RT-PCR. Compared with PCR, ID NOW had sensitivity and specificity of 83.1% [95% confidence interval (CI) 75.4-88.7] and 99.5% (95% CI 99.3-99.6), respectively. PPV and NPV were 76.9% (95% CI 69.0-83.2) and 99.6% (95% CI 99.5-99.8), respectively. The median time from arrival in the ED to ID NOW result was 59 min.
ID NOW provides a rapid and reliable adjunct for the safe triage of patients with COVID-19, and can work effectively when integrated into an ED triage algorithm.
在急诊科（ED）对有 2019 年冠状病毒病（COVID-19）风险的患者进行隔离的决策必须迅速而准确，以确保及时治疗并维持患者流量，同时将医院内传播降至最低。逆转录聚合酶链反应（RT-PCR）检测太慢而无法实现这一目标，因此越来越多地使用床边检测来促进分诊。ID NOW 严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）检测是一种等温核酸扩增床边检测，针对 RNA 依赖性 RNA 聚合酶基因。
评估 ID NOW 作为大型急性医院急诊科收治的 COVID-19 分诊工具的诊断性能。
纳入 2021 年 3 月 31 日至 7 月 31 日期间，有有效 ID NOW 和 RT-PCR 结果的所有从 ED 转入的成年急性内科患者。计算 ID NOW 的诊断准确性[敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）]与实验室参考标准相对应。使用循环阈值值和临床数据进一步探索差异结果。
2%（124/6050）的内科入院患者 RT-PCR 检测 SARS-CoV-2 阳性。与 PCR 相比，ID NOW 的敏感性和特异性分别为 83.1%（95%置信区间[CI] 75.4-88.7）和 99.5%（95% CI 99.3-99.6）。PPV 和 NPV 分别为 76.9%（95% CI 69.0-83.2）和 99.6%（95% CI 99.5-99.8）。从 ED 到达至 ID NOW 结果的中位数时间为 59 分钟。
ID NOW 为 COVID-19 患者的安全分诊提供了快速可靠的辅助手段，当整合到 ED 分诊算法中时，可以有效发挥作用。
